Texas group health insurance
Texas sets out its small employer health rules in Chapter 1501 of the Insurance Code, overseen by the Texas Department of Insurance. The state uses the federal 50-employee line, and the federal SHOP Marketplace serves Texas employers through healthcare.gov.
Texas law also lets carriers set participation and contribution requirements for small groups, within limits written into the administrative code.
A free matching service for employers, not a broker or insurer. We introduce you to a licensed broker and tell you who they are before anything is shared. No plan, tax or legal advice. How it works
What Texas employers should know
- Small employer plans follow Texas Insurance Code Chapter 1501.
- The small group line is the federal 50 employees.
- Participation and contribution rules sit in 28 Texas Administrative Code 26.8.
- There is no state-run marketplace: SHOP is through healthcare.gov.
- Many Texas employers have staff in several metros, each with different networks.
- Brokers need a Texas general lines or life, accident and health license.
Texas at a glance
| Item | Texas |
|---|---|
| Small group size Federal definition | 1 to 50 |
| State law Texas Insurance Code | Ch. 1501 |
| Marketplace for employers Federal SHOP | healthcare.gov |
| National family premium, for reference KFF 2026 average, all states | $28,303 |
Sources: TDI consumer guide, Tex. Ins. Code 1501.003, 28 TAC 26.8 and KFF 2026 Employer Health Benefits Survey. Read October 28, 2026. The KFF figure is a national average, not a Texas rate.
One state, several health care markets
Texas is large enough that a plan which works in Houston may have a thin network in El Paso or the Panhandle. For an employer with people in more than one metro, the network matters as much as the premium: ask the broker to check that each employee's nearest hospitals and doctors are in network before you choose.
The Texas code allows carriers to require minimum participation and an employer contribution for small groups, and it spells out how employees with other cover are counted. A broker should show the carrier's requirement on the quote rather than leave it for the application.
| Small employer health plans | Texas Insurance Code Chapter 1501 |
|---|---|
| Participation and contribution | 28 Tex. Admin. Code 26.8 |
| Regulator and consumer help | Texas Department of Insurance |
| Marketplace for employers | Federal SHOP on healthcare.gov |
General information, not legal advice.
Six questions for a Texas broker
The usual list, with one Texas question added.
Their license, in your state
A resident or non-resident producer license with accident and health authority wherever you have employees. You can check it on your state insurance department's site (the NAIC lists every department).
How they are paid
Commission from the carrier, a flat fee from you, or both. Federal rules require brokers to disclose expected pay of $1,000 or more for a group health plan in writing before you sign (DOL guidance, 2021).
Which carriers they can quote
Brokers can only place cover with carriers that have appointed them. Ask which carriers and funding types they will take your group to, and whether any are left out.
Networks in every metro you hire in
Whether the carriers they quote have strong networks where each of your employees lives, not only at head office.
What happens after you sign
Who handles enrollment, adding and removing employees, billing errors and claim problems during the year, and how quickly they reply.
Compliance help
Whether they help with ACA reporting, Section 125 premium-only plans, COBRA or state continuation notices and plan documents, or expect your payroll provider or attorney to do it.
A Texas employer with staff in one metro or several? We will find a licensed Texas broker who works with groups your size.
Find a licensed brokerSetting up a Texas group plan
Census by ZIP code
Where each employee lives decides both rates and networks.
Quotes and network checks
The broker compares plans and checks networks for your people.
Applications
Employer application, employee enrollments and waivers, first premium.
Renewal planning
Review starts two to three months before the plan year ends.
Questions people ask
What is a small employer in Texas for health insurance?
Texas follows the federal 1 to 50 employee small group definition. The detailed rules are in Chapter 1501 of the Insurance Code; a broker will confirm how your headcount is counted.
Does Texas have its own health insurance marketplace for employers?
No. Texas employers use the federal SHOP Marketplace through healthcare.gov, or buy directly from carriers through a broker.
Can a Texas carrier require a minimum participation rate?
Yes, within the limits in 28 Texas Administrative Code 26.8, which also covers contribution requirements and how waivers are counted.
Are Texas employers required to offer health insurance?
Texas has no general state requirement. The federal rules for employers with 50 or more full-time equivalent employees apply.
Are you a Texas insurance agency?
No. We are a national matching service and hold no insurance license. We introduce you to a licensed Texas broker.
Find a Texas group health broker
Three short steps: where the business is, what you have now, and who to speak to. It takes about two minutes and asks nothing about anyone's health.
- Free for employers. The broker pays us a flat fee per introduction.
- One broker, named to you first, with their state license number.
- No advice from us. Plans, rates and tax questions go to the licensed broker.
We are a free matching service, not a broker or insurer, and we do not quote or recommend plans. We look for a licensed benefits broker who suits your business and tell you who it is; your enquiry goes to them only with your go-ahead.
Thanks, your enquiry is in.
- Within one business day we will email or call to tell you which licensed benefits broker we have found, with their license number.
- Your details reach that broker only if you say yes.
- The broker reviews your renewal or your options and talks you through them. Whether to work with them is your choice. No marketing from us, ever.