Welcome to our home page. We carefully developed it for the individual and small business owner in the market for personal or group insurance benefits. Over the years our insurance customers have told us their needs and what they are looking for when shopping for benefits. This page will provide basic product information, clear category explanations and a couple of options to choose from. When you are ready to buy you can send us an email to receive a quote from multiple carriers or apply on-line. During the course of our lives we will find ourselves shopping for insurance benefits at several stages of life. You may find yourself looking for a life insurance policy soon after the birth of a child or the purchase of a new home. A disability insurance policy can help protect your income incase of a sudden injury that prevents you from going to work. Business overhead policies can protect the income of your employees for a period of time until you recover. Whether you are a self employed professional or have found yourself between jobs this page is an excellent resource for information that can answer many questions.

Health Plan Basics Health care plans pay for most, and sometimes all, of the treatment costs for illnesses and injuries. They can generally be classified as either “fee for service” or “managed care.” Many people obtain health coverage as part of a group – such as an employer, professional association, or other organization – that offers health coverage to its employees or members. Others may buy individual health coverage directly from an agent or insurer. The type of plan you have and how you obtained it usually determines the benefits included, how you access and receive medical care, and what you’ll have to pay out of pocket.   Premiums. A premium is a fee to participate in the plan. You’ll have to pay premiums for as long as you have coverage. If you have a plan through your work, your premium will likely be deducted from your paycheck. Employers who offer health plans usually contribute toward some or all of your premium costs, but they aren’t required to do so. Deductibles. A deductible is an amount that you must pay out of your own pocket before your plan will begin to pay. If you have a family plan, the deductible may apply to your entire family, or each individual may have a separate deductible. You’ll usually have to meet your deductible each year. Many insurance companies offer high-deductible options for plans. In general, the higher your deductible, the lower your premium will be. Coinsurance. Once you’ve met your deductible, most fee-for-service plans will pay a percentage of the remaining cost for covered health services and require you to pay the rest. This cost-sharing is called coinsurance. The coinsurance will vary by plan. For instance, some plans may pay 80 percent of the cost, leaving you to pay 20 percent, while others may pay 70 percent, leaving you to pay 30 percent. In Texas , health plans must pay at least 50 percent of the cost of covered services after the deductible has been met. As with deductibles, the higher the amount you pay in coinsurance, the lower your premium will be. Health maintenance organizations (HMOs) generally require you to receive health care only from providers within the HMO’s network. There are exceptions for medical emergencies and when medically necessary services are not available within the network. With an HMO, you’ll choose a “primary care physician” from a list of doctors in the HMO’s network. Your primary care physician oversees all of your medical care and provides referrals to specialists and other providers. HMOs usually pay primary care physicians a set monthly fee – called a capitation fee – for each member, regardless of the amount of covered services performed. HMOs with a point-of-service (POS) option allow members to use providers outside the HMO’s network without first having to receive a referral. However, if you use providers outside the network, you’ll have to pay more for your health care. A POS plan may exclude the option for out-of-network care for certain medical conditions. POS coverage is usually offered as a “rider,” or an add-on to the contract, for an additional fee. Preferred provider organization (PPO) plans allow you to go to any provider you choose. However, you’ll pay less if you use providers in the PPO’s network. You don’t have to select a primary care physician to oversee your care in a PPO plan. Group vs. Individual Coverage Group health plans Group plans are commonly offered by employers as part of an employee benefits package. They can also be obtained through some trade unions, professional associations, churches, and other organizations. Most Texans with health coverage are in employer-sponsored group plans, through either their own employer or their spouse’s employer. The state and federal laws for group plans are somewhat different depending on the size and nature of the group. Texas law contains special provisions for plans offered by small businesses. For instance, some state-mandated benefits that must be included in plans offered by large employers do not have to be included in small-employer plans. Employers and groups aren’t required to offer health coverage to their employees and members. Those that do are not required to contribute toward plan premiums. Some carriers, however, may require employers to pay 50 percent or more of an employee’s premiums. Following is a brief description of the most common types of group health plans: Small-employer plans are plans sponsored by businesses with between two and 50 eligible employees. Eligible employees must be full-time employees who usually work at least 30 hours a week. In addition, they may not have health coverage through some other source and must not be seasonal, part-time, or substitute workers. If a small employer offers a plan, it must be made available to all eligible employees equally. State law sets a 15 percent cap on annual rate increases due to members’ health status for small employer health plans. Also, any carriers who discontinue a small employer plan must automatically accept the group into any other employer plan that they offer, regardless of any enrollment requirements. Large-employer or other group plans are offered by businesses that don’t meet the small employer requirements and don’t self-fund, and by other groups, such as a churches, trade unions, and professional associations. If a large employer offers an HMO plan only, the law requires the HMO to offer a point-of-service option. Individual Health Plans Insurance companies and HMOs sometimes sell coverage directly to individuals. These policies can cover the purchasing individual only or include a spouse and dependents. Individual plans can be a good option if you’re self-employed or work for a company that doesn’t offer a health plan. In general, individual plans cost more, and may cover fewer conditions, than employer-sponsored plans or other group plans. Group plans achieve lower rates by spreading the risk of claims over a greater number of people. The following are common types of coverage you can usually buy as an individual: HMO plans – Managed care plans offered by HMOs that pay for covered health services as long as you use your particular HMO’s network of providers or receive preauthorization for obtaining care outside the network. Major medical policies – Policies that cover hospital stays and physician services in and out of the hospital. Major medical policies also may be offered as PPO plans. Hospital surgical policies – Policies that cover only expenses directly related to hospital and surgical services, such as daily room, surgery, and doctor charges. Hospital indemnity policies – Policies that pay up to a fixed amount for each day you are in the hospital. Specified or dread disease policies – Policies that only cover specific illnesses detailed in the policy, such as cancer or AIDS. This coverage also may be offered as a rider to extend the other types of individual coverage. Short term policies – Policies that only last for a specified length of time, not to exceed 12 months. Short-term policies are most often purchased as a “fill-the-gap” measure by people who lose coverage for some reason but expect to gain it back. Health Individual Health Family Plans Family Health Insurance Plans PPO HMO H.S.A M.S.A Child only Coverage Cobra Short Term Medical Travel Insurance International Travel Insurance Patriot Insurance Student Health Plans Student Health Insurance Temporary Health Insurance Life Term Universal Life Whole Life Final Expenses Key Man Insurance Golden Handcuff insurance Buy Sell Agreements Business Continuation Disability Short Term Disability Long Term Disability Business Overhead BOE Income replacement Income Protection Dental Individual Dental Dental Insurance Group Dental Plans Dental Discount Plans Family Dental Plans COBRA Protection If you lose your group coverage for employment-related reasons, you may be able to keep your coverage for a limited time, although your employer will no longer continue any contribution toward your premium. COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federal law that gives employees, and in some cases retired employees, the right to continue group health coverage for a specified period. You may extend coverage for yourself for up to18 months, and for your spouse or any dependent children for up to 36 months. COBRA generally only applies to employees who lose their coverage because of reduced work hours or lose their job for reasons other than “gross misconduct.” COBRA applies to all employer health benefit plans with 20 or more employees, except plans sponsored by the federal government and certain church-related organizations. COBRA also enables a spouse and dependent children to continue coverage when an employee is entitled to Medicare, divorces, or dies. An employee’s children qualify for continued coverage under COBRA if they lose “dependent child” status under the rules of the health benefit plan. An employee, spouse, or dependent child has 60 days after qualifying for COBRA coverage to decide whether to take it. If accepted, the cost to the employee, spouse, or dependent child is the full premium, plus a 2 percent administrative fee. Depending on the situation, coverage may continue for 18 to 36 months, but may be slightly longer in some situations. If you elect continuation of HMO coverage through COBRA and move out of the service area, you will be covered only for emergency services. For more information, call the Dallas office of the U.S. Department of Labor’s Employee Benefits Security Administration If you meet certain criteria, Texas law requires your group plan to allow you to continue coverage for six months. The six-month “continuation period” begins after any federal COBRA extension period ends, or begins immediately if COBRA coverage does not apply. Therefore, if you are eligible and opt for COBRA coverage, you may have a total of 24 months to find new health care coverage. Before the Texas continuation period ends, your group plan is also required to provide you with information on how to enroll in the Texas Health Insurance Risk Pool. Texas Health Insurance Risk Pool (Health Pool) The Health Pool offers health insurance to Texans who can’t find coverage because of their medical condition and to certain individuals who have recently lost their employer-sponsored health coverage. The Health Pool is generally the most comprehensive option you will find if you can’t get traditional coverage. The policy offers major medical coverage similar to coverage offered in the commercial individual market. Premium rates are determined by the member’s age, gender, tobacco use, and residential ZIP code, without regard to health status. Premium rates may be up to twice the standard rate in the individual health insurance market. For more information, including eligibility requirements and benefits information, call the Health Pool or visit its website: 1-888-398-3927 (TDD 1-800-735-2989) www.txhealthpool.com   Our Carriers AIG American General Life Aetna Aetna Dental Humana Humana-One Humana Dental Mutual of Omaha United of Omaha Unicare Unicare Dental Delta Dental United Healthcare Assurant Assurant Health Insurance John Alden John Alden Life John Alden Dental Mass Mutual Unum-Provident IMG International Medical Insurance Global Insurance Guardian-Brookshire   Coverage We offer Texas Health Plans Texas Health Insurance Texas Student Insurance Texas Student Health Insurance Texas Student Select College Insurance College Student Insurance Student Health Insurance Texas College Health Plans Global Insurance Texas Texas Insurance Quotes Texas Disability Insurance Texas Life Insurance Houston Health Insurance Texas Group Benefits Small Business Benefits Texas Life Insurance