Medical & virtual care
HMO/EPO/PPO/HDHP designs with integrated telehealth (virtual PCP, urgent care, behavioral health). HDHPs pair with HSAs.
Start your Texas group benefits quote
Employee Benefits Quote Texas — 2026 Group Medical, Dental, Vision, Life/AD&D, Disability & Tax-Advantaged Accounts
Get a fast, accurate employee benefits quote in Texas. We compare carriers, networks, and funding models—fully-insured, level-funded/ASO, and ICHRA—then align plan design (HMO/EPO/PPO/HDHP) with eligibility, contributions, and compliance. If you’re searching “near me,” our local/virtual team covers all major TX metros.
Quick facts — Texas (2026)
| Topic | What to know |
|---|---|
| Small employer (TX) | Generally 2–50 employees on business days in the preceding calendar year; at least two employees on the first day of the plan year. |
| Guaranteed issue | Small-group medical is offered on a guaranteed-issue basis (issuer eligibility/enrollment rules still apply). |
| Waiting period (federal) | Employer plan waiting periods may not exceed 90 days. |
| State continuation | If not COBRA-eligible, TX allows up to 9 months of continuation; after COBRA, insured plans may permit up to 6 additional months (plan-dependent). |
| Telehealth parity | Texas law supports coverage for telemedicine/telehealth on applicable insured plans; parity provisions continue in 2025–2026. |
| Funding models | Fully-insured, level-funded/ASO, ICHRA (any size), QSEHRA (<50 FTEs without a group plan). |
| Effective dates | Groups can start any month; small-group plans include at least a 31-day initial and an annual open enrollment window. |
| Primary action | Start your group quote |
Notes: State mandates apply to insured plans. Self-funded (ERISA) plans follow federal rules unless they choose to mirror state provisions.
Plan & funding options at a glance
We’ll map your workforce (locations, networks, risk tolerance) and compare 12-month total cost—not just month-one premiums.
| Option | How it works | Best for | Consider |
|---|---|---|---|
| Fully-insured (HMO/EPO/PPO/HDHP) | Predictable premiums; broad networks; HDHP pairs with HSA | Stability & simpler admin | Less claims transparency; renewal adjustments |
| Level-funded / ASO | Claims-based with stop-loss; potential surplus refunds | Groups with stable risk & good participation | Variable costs; requires compliance hygiene |
| ICHRA | Employer allowance; employees select individual plans | Multi-site/variable-hour teams | Member experience tied to local individual market |
| QSEHRA | For <50 FTEs without group plan; reimburse within caps | Very small employers | APTC coordination; MEC requirements |
Common benefits & add-ons
Dental & vision
Dental PPO/DHMO with ortho riders; vision with exam/hardware allowances. Bundling can unlock multi-line discounts and single-bill admin.
Life/AD&D & disability
Employer-paid basic life with buy-ups; STD/LTD to protect income. Review portability/conversion and pre-existing provisions.
Accounts & reimbursements
HSA, LPFSA/FSA, HRA, ICHRA, and QSEHRA for tax efficiency and choice.
Costs, employer contributions & savings
Rates reflect region, ages, network, plan design, participation, and contribution strategy. Optimize for total value, not just sticker premium.
| Driver | What influences cost | How to save |
|---|---|---|
| Funding model | Fully-insured vs level-funded/ASO vs ICHRA/QSEHRA | Quote all three; align to risk tolerance & cash flow |
| Network & design | HMO/EPO vs PPO; HDHP/HSA; copay vs coinsurance tiers | Map members to providers before choosing network |
| Participation | Minimum enrolled after valid waivers | Employer-paid base + buy-ups to lift take-up |
| Contribution policy | % or fixed dollar; composite vs age-banded | Set simple rules; audit waivers annually |
| Virtual care | Telehealth utilization & navigation | Promote first-call virtual PCP/behavioral pathways |
Eligibility, participation & enrollment
Rules vary by carrier and line of coverage. We’ll verify specifics for your business before setting effective dates.
| Topic | Typical rule | What we verify | Pro tip |
|---|---|---|---|
| Employer size | 2–50 small-group; 51+ large group | Common-law employees; controlled-group status | Maintain clean payroll & org docs for underwriting |
| Waiting period | Max 90 days from eligibility to enrollment | Orientation period; measurement/stability for variable-hour staff | Time eligibility to reduce gaps for new hires |
| Participation | Carrier minimums after valid waivers | Eligible vs ineligible classes; probationary periods | Use employer-paid base + voluntary buy-ups |
| Continuation | TX continuation up to 9 months if not COBRA-eligible; up to 6 months after COBRA (insured plans) | Which law applies (COBRA vs state) | Publish a simple off-boarding checklist |
| Effective dates | Usually 1st of month; year-round starts possible | Binder payment & census completeness | Align medical+dental+vision renewals |
Local service areas & licensed states
Texas metros we serve
- Dallas • Fort Worth • Houston • Austin • San Antonio
- El Paso • Plano • Arlington • Corpus Christi
- Frisco • Lubbock • McAllen • Waco • Round Rock
Licensed states
Virtual/local appointments available in:
AZ, AL, TX, CA, NY, OH, FL, NC, VA, GA, OK, NM, IA, KS, MI, NE, SC, SD, WV
What to have ready
- Employee census (names, ZIPs, ages, eligibility)
- Preferred providers & any current plan documents
- Target contribution strategy & effective date
Texas employee benefits — FAQs
How does Texas define a small employer for group medical?
Generally an average of 2–50 employees on business days in the preceding calendar year, with at least two employees on the first day of the plan year.
What are Texas continuation rules vs. COBRA?
COBRA applies to most employers with 20+ employees (18–36 months by qualifying event). For insured small groups, Texas state continuation typically allows up to 9 months; after COBRA, many insured plans allow up to 6 additional months.
Is telehealth covered on Texas employer plans?
Yes—Texas law supports coverage for telemedicine/telehealth on applicable insured plans. Self-funded ERISA plans follow federal rules and the plan document.
Can we begin our group plan any month?
Yes. Groups commonly start on the first of any month. Small-group plans include at least a 31-day initial and an annual open enrollment window.
Should we consider ICHRA or QSEHRA instead of a traditional group plan?
Often worth modeling. ICHRA works for any size employer and supports multi-location hiring; QSEHRA suits <50 FTEs that don’t offer group coverage. We’ll compare alongside fully-insured/level-funded options.
Disclosure
Independent agency: Blake Insurance Group LLC compares multiple carriers to align Texas group benefits with your workforce and budget.
Brand ownership: All product/brand names are trademarks of their owners. Availability, benefits, and eligibility vary by carrier and state.
Licensing: Licensed insurance producer (NPN 16944666). Licensed in the states listed above.
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