Private group plans available to Texas small businesses include: Fully-Insured Group Plans Traditional small group health insurance for 2 to 50 employees Underwritten by carriers like Blue Cross Blue Shield of Texas, UnitedHealthcare, Cigna, Humana, and Aetna Available in HMO, PPO, EPO, and HDHP plan designs Premiums are fixed for the plan year and renewed annually Carrier handles all claims, network management, and compliance Level-Funded Health Plans A hybrid between fully-insured and self-funded coverage Available to most small groups with 5 or more enrolled employees The employer pays a fixed monthly amount that covers expected claims, stop-loss insurance, and admin If actual claims come in below the projection, the employer may receive a refund at year-end Often priced more competitively than fully-insured plans for healthier groups ICHRA (Individual Coverage HRA) Employer reimburses each employee for a private individual health plan, tax-free No minimum participation, no minimum group size, no employer contribution floor Employer sets a monthly reimbursement budget by class (full-time, part-time, salaried, hourly, location) Employees choose any compliant individual plan, including off-exchange Texas plans Counts as an offer of coverage for ACA mandate purposes for ALEs QSEHRA (Qualified Small Employer HRA) Designed for businesses with fewer than 50 FTEs that do not offer a group plan 2026 contribution limits: $6,450 per year for self-only and $13,100 per year for family Employer reimbursements are tax-free to the employee and tax-deductible to the business A simpler alternative to a full group plan for very small employers Association Health Plans and PEOs Group purchasing arrangements through industry associations or professional employer organizations Can offer access to large-group rates for very small businesses Subject to additional federal rules around what counts as a bona fide association For most Texas small business owners with 2 to 50 employees, the choice comes down to a fully-insured group plan, a level-funded plan, or an ICHRA
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