How We Shop Large Group Health Insurance in Texas: Census, Claims Data, Quotes, and Renewal
We shop large group health insurance in Texas in seven steps: the census, the claims data, the funding lanes, the market request, underwriting, one written comparison, and the network check on the exact plan. The steps are the same at 50+, 100+, and 250+ employees, and our broker cost to the employer is $0.
We are an independent employee benefits brokerage based in Corpus Christi and licensed across Texas. Texas calls an employer large when it averaged at least 51 employees on business days in the preceding calendar year, and the federal Applicable Large Employer line is 50 full-time equivalents. We shop both. 40 Google reviews.
How we shop large group health insurance in Texas: seven steps
Every large group moves through the same sequence. Size changes how deep each step goes, not the order.
| Step | What we do | What you do |
|---|---|---|
| 1. Census and goals | Build a clean census and write down budget, contribution, hospitals, and funding appetite | Send the census and name the goals |
| 2. Claims data | Request the claims report in writing under Texas law | Sign the request and the HIPAA certification |
| 3. Funding lanes | Decide which of fully insured, level-funded, and self-funded to price | Say how much claims risk the company will carry |
| 4. Market request | Send one census and one plan design to every carrier that fits | Approve the plan design |
| 5. Underwriting | Read every condition the market attaches | Answer follow-up questions |
| 6. Comparison | Put the renewal and every quote on one sheet | Pick a design |
| 7. Network check and bind | Confirm hospitals on the exact plan ID, then run enrollment | Sign and tell your staff |
Step 1: the census and the goals
The census is each eligible employee's date of birth, gender, home ZIP, and coverage tier, plus every work state and the legal entity that will hold the policy. Texas lets a large employer set its own participation criteria, but they cannot rest on health status, so we write the eligibility rule down before a carrier sees the file.
Then the goals: the budget, the employer contribution, the hospitals your people use by campus, and how much claims risk the company will carry. A group with staff in other states needs every work state and home ZIP on the census, and a multi-state group health insurance broker checks situs and networks.
Steps 2 and 3: claims data and funding lanes
Chapter 1215 of the Texas Insurance Code gives a plan sponsor the right to request its claims report in writing. The issuer has 30 days to deliver up to 36 months of paid claims, premium, and enrollment. We ask for it first, because it informs every funding lane.
Three lanes can go on the sheet. Fully insured is a fixed premium, and the carrier takes the claims risk. Level-funded is a fixed monthly payment where part funds claims and stop-loss caps the downside. Self-funded means the employer funds claims through an administrator and buys stop-loss. We quote all major carriers and several regional ones, fully insured and level-funded. Healthy groups that underwrite for it often see level-funded land about 15% to 30% under a comparable fully insured quote. That is a planning note, not a promise on your census. Self-funded vs level-funded health insurance in Texas covers when the third lane belongs on the sheet.
Stop-loss sets the risk on the two lanes that carry claims. Specific stop-loss caps what the plan pays on one person. Aggregate stop-loss caps the group's total. A carrier can also raise the specific deductible for one named person, which the market calls a laser. We read all three terms before a quote goes to the owner.
Steps 4 and 5: the market request and underwriting
We send the same census and the same plan design to every carrier and administrator that fits the group, with the same effective date, so the answers compare. A Texas large employer can also ask an issuer for a summary of all the plans it is eligible for, and we use that to see what a carrier will write at your size.
Underwriting is where the number moves. A Texas issuer may decline a large group under its underwriting standards, and once it accepts, it must take the whole group of eligible employees who choose coverage. The market answers with conditions: the contribution and participation level written into the contract, the stop-loss terms, and limits on the plan design. We read the conditions, not only the rate.
Step 6: one written comparison
Every quote goes on one sheet next to the renewal. It shows the employer share, what each employee pays by coverage tier, the deductible and out-of-pocket maximum by plan, the funding type, the stop-loss terms, the participation and contribution rule, and what the carrier says about the next renewal.
We put our own pay on that sheet in writing before you sign. Issued quotes are the answer, so we do not promise a result before the market responds. If a quote needs a higher employer contribution or a different plan design to bind, the sheet shows that before you choose.
Step 7: the network check, waivers, and enrollment
Before anyone signs, we confirm the hospitals and physicians your people use on the exact plan ID, by home ZIP and campus, not by carrier name. Then we bind. Texas requires the issuer to get a written waiver from each eligible employee who declines coverage, and the employer decides whether to set a waiting period.
We run enrollment: elections, waivers, ID cards, and the first bill. Build 60 to 90 days when you can. Underwriting on a large group takes longer than a small-group turn, and the claims report alone can take 30 days.
Renewal: we shop it again
Texas gives a group at least 60 days of written notice before a premium increase takes effect, and the carrier cannot require an answer before the 45th day. We start when the letter arrives, or sooner. We ask for a fresh claims report, run the same steps on the current census, and put the renewal next to the market. The full process, from census to renewal, is in large group health insurance in Texas.
How we are paid
Our broker cost to the employer is $0. Carrier commission is already inside the published premium whether you use a broker or go direct, so skipping the broker does not lower your rate. On a level-funded quote, we set our PEPM, our per employee per month amount, in the quote. It sits inside the monthly carrier payment, never as a separate bill. PEPM vs commission explains how Texas benefits brokers get paid.
For planning only, full single medical runs about $625 to $680 per employee per month in 2026, and a 50% employer contribution to employee-only is about $313 to $340 per enrolled employee. Those are estimates, not a large group quote.
Frequently Asked Questions
Do you only work small groups?
No. We shop groups at 50+, 100+, and 250+ employees with no cap on size, through the same independent process as smaller books.
How long does a large group shop take?
Build 60 to 90 days when you can. Underwriting takes longer than on a small-group sheet, and the Texas claims report can take up to 30 days to arrive.
Which funding lane fits a large group?
Any of the three can. The claims report, the census, and the stop-loss response decide it. We quote all major carriers and several regional ones, fully insured and level-funded when they fit, and we raise self-funded when cash flow and claims predictability support it.
Do you name a carrier before you see the census?
No. The census and the market's response decide the carrier. No named carrier fits every large group.
The short answer
We shop large group health insurance in Texas by building the census, requesting the claims report, pricing the funding lanes that fit, and comparing every quote and the renewal on one sheet before you sign. We confirm the hospitals on the exact plan ID. Our broker cost to the employer is $0. Groups 2 to 250+. We do not cap. 40 Google reviews.
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Send your large group census and renewal date
Send the census and the renewal date. We will say which funding lanes fit and what the market returns before anyone binds. Corpus Christi base. Statewide license. Clint Wallace, Lic 3200999 / NPN 21250478. Groups 2 to 250+. We do not cap.
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