Frequently Asked Questions

Click on the question for answers on General Questions, Small Group & Individual Coverage.


General Questions

Where do I send my premium payments and/or correspondence?

SBOTIT Plan payments can be mailed to: State Bar of Texas Insurance Trust, PO Box 1297, San Antonio TX  78295-1297; correspondence should be sent separately to 206 E. 9th Street, Suite 1501, Austin, TX  78701 or faxed to 512-479-4109.

Besides my law practice, I also run other types of businesses. Can your office assist in getting my other businesses coverage for health, dental life and vision?

Yes.  We have licensed agents in our office that can quote any small group in Texas.

When is the last day to pay my SBOTIT premium?

Premiums are due on the 1st day of the month.  A grace period of 31 days from the due date will be granted, during which the policy shall continue in force.  If the premium is not received before the expiration of the grace period, no claims incurred during that grace period will be honored and the policy shall be deemed to have terminated on the premium due date.

Can I make a payment for my SBOTIT plan over the phone or online?

We currently do not have an online bill payment option nor do we take payments over the phone.  We do offer an Electronic Fund Transfer Program for our SBOTIT plans through which you authorize us to deduct your monthly premium from a designated checking or savings bank account of your choice.  If you wish to enroll in this program, you must complete an Electronic Transfer Form. Depending on when the form is received, the first deduction may take as long as one month to initiate a deduction.

 

We are not happy with our agent of record. Can we change and have your office become our agent of record?

Yes.  Contact our office at 1-800-460-7248 and we will help you work through these details.

What is the difference between an HMO, PPO, and HDHP?

HMO = Health Maintenance Organization:  These plans require that you select a primary care doctor to coordinate all of your care.  In order to see specialists you will need a written referral from your primary care doctor.  Any care received without primary care authorization will not be considered a covered benefit.

PPO = Preferred Provider Organization:  Plans have in and out of network benefits.  In – network benefits typically consists of primary care and specialists copays along with a number of other varying copays.  There are also separate in and out of network deductibles and coinsurance.  Some carriers combine the in and out of network deductibles and coinsurance where others do not.  Out of network benefits are typically just deductible and coinsurance, no copays.  You will receive you highest level of benefits by staying in-network.

HDHP = High Deductible Health Plan:  An HDHP is a type of health insurance plan that offers lower monthly premiums than more traditional plans like PPO’s or HMO’s in exchange for a higher deductible – hence the name “high deductible health plan”.  They are usually paired with a Health Savings Account (HSA) that allows the insured and/or their employer to make tax deductible contributions.  The funds contributed to an HSA account are not subject to federal income tax at the time of deposit.  HSA funds may currently be used to pay for qualified medical expenses without federal tax liability or penalty.  Over time, if medical expenses are low and contributions are made regularly to the HSA, the account can accumulate significant assets that can be used for health care tax free or used for retirement on a tax-deferred basis.

What is the definition of dependent?

Dependents are spouses/domestic partners and child(ren) of the attorney/employee.

How do I cancel my Individual or Small Group coverage?

Written authorization must be submitted to the SBOTIT via fax at 1-512-479-4109, emailed to info@sbotit.com, or mailed to SBOTIT, 206 E. 9th St. Suite 1501, Austin, TX  78701.  Request for cancellation of Small Group plans should be made on company letterhead.

What is the difference between the State Bar of Texas Insurance Trust (SBOTIT) and the SBIT Insurance Agency, LLC?

The SBOTIT offers Life, Disability, Office Overhead, and a few other select products exclusively to members of the State Bar of Texas and their families.  The SBIT Insurance Agency, LLC is wholly owned by the SBOTIT and is licensed in Texas to offer Life, Health, and Dental insurance products to members of the Bar and the general public through its appointed companies.

Small Group Coverage Questions

If my law practice consists of just me the attorney and one full time employee, are we eligible for small group coverage?

Yes.  You are required to maintain two full time employees enrolled at all times, or 75% of your eligible work force.

My law practice consists of me and my wife who works full time for me at the firm. Are we eligible for small group coverage?

• Yes.  Carriers will cover husband and wife teams but will require that there be a payroll report or a TWC report on the working spouse.

If my group has health coverage under our Payroll Company, can we terminate that coverage and seek coverage for just our own small group, but with the same carrier?

Yes.  Because Payroll Companies cover all their clients under one health plan, you can be quoted as new business with the same carrier, just for your group.  The rates will be different because you are then taking the risk for just your group and not everyone else’s.

If my group has health coverage under our Payroll Company, can we terminate that coverage and seek coverage for just our own small group, but with the same carrier?

Yes.  Because Payroll Companies cover all their clients under one health plan, you can be quoted as new business with the same carrier, just for your group.  The rates will be different because you are then taking the risk for just your group and not everyone else’s.

Is maternity a covered benefit on small group plans?

Yes.  Maternity is covered as any other illness in Texas.

Can we remove maternity coverage from our small group plan?

There is one Carrier who is able to remove maternity coverage.

Can our group be declined coverage?

Small group coverage in Texas is guaranteed coverage.  The underwriters with the various carriers may rate the group up if they see any high risk factors, but the small group cannot be declined.

The initial small group quotes we received from your office are called Base Rates. What does this mean?

Quotes are run with various carriers with basic census information provided by your firm, (i.e. name, date of birth, sex, location).  The initial rates are based upon this census information.  Final rates are not provided until the firm selects a carrier, completes their enrollment packet and is reviewed by the carrier specific underwriters.  After the underwriters review, you are presented with the Final Rate to accept, decline or change plans.

As new business, if there are some serious medical conditions in my group, how much can my rates increase from the base rates?

In Texas, carriers are limited to an increase of 67% from the base rates on new business.

What size groups are considered small group in Texas?

2 to 50 full time employees.

What does “eligible employees” mean when you say there must be 75% of the “eligible employees” covered on the group plan?

Eligible employees are full time individuals who do not have other group coverage (i.e. through a spouse).  For example, a firm has 10 full time employees, two of which have coverage through their spouse’s employer.  Of the 10, 8 are considered eligible employees and 75% of the 8 is 6.  Therefore, six (6) employees must enroll in the group coverage to maintain small group status.

What happens if my group falls below 75% of eligible employees enrolled?

The carrier will terminate the group upon verification of this information.

What is the difference between new business and renewals?

If your group is currently without small group coverage, then the Carriers will view you as new business.  There is a cap on how much a carrier can increase your base rates as a new business client.

Groups enrolled with a carrier are considered a renewal group after a 12 month period.  The firm rates are reviewed every 12 months.  At this renewal time, the firm rates can either increase or decrease based upon a number of factors.

My group is currently enrolled with a known carrier for health and dental. Our renewal rates with this carrier are too high. Can we have this same carrier re-quoted thru your office and receive cheaper rates?

No.  Renewal groups cannot be quoted as new business with the same carrier.  If you do not already have an agent, then we can assist you in getting alternate renewal rates with your current carrier.

I already have group coverage and an agent that has searched the market for our firm. I am not happy with the base rates we are being provided. Can your office provide our firm with cheaper rates?

No.  The rates for small groups are based on the basic census information provided by your firm, (i.e. name, date of birth, sex, location).  The base rates will not change if you go through an agent in our office or another agent in the market because the census information remains the same for your group.

What is the benefit of quoting small group through your office vs. other agents?

Our office has licensed agents that can search the market, with a number of “A”rated companies to help you find the best fit.  We specialize in working with Texas attorneys and their law firms.  We have established direct contacts with the various carriers that help us in assisting you resolve a number of issues that may arise.  We know your time is valuable and will assist you in sorting thru the data so you can make choices that best fit your needs.

We also do the billing for the Aetna Small Group plans out of our office.  This allows us to resolve a number of issues more quickly.

Can I get small group coverage for my firm if my business start date is in the future?

Carriers will require specific documents to show that you are operating as a small business in Texas.  In addition to this they will require a payroll report of at least two weeks of pay on the books.

I have offices in Texas and other states. Can I cover all my employees in all states?

Some carriers will cover all employees in all states BUT only if the home office is in Texas.  Eligibility rules would apply.

When is the best time to have our carrier specific enrollment packet to your office if we want a first of the month effective date?

It is best to make your carrier selection request by the 10th of the month.  In most cases we will need the original signed documents (some carriers will accept scanned copies) in our office by the 15th of the month.

It is five days before the first of the month and I need a first of the month effective date. Can this be accomplished?

Yes, but please be aware that any enrollment packet received after the 15th of the month for a first of the month effective date will have eligibility verification delayed.  This means the carriers will honor the first of the month effective date, as long as all documents and signatures are in place.  Eligibility will not be visible to the providers (including pharmacies) for 7 to 10 working days after eligibility has been sent for set up.  Claims incurred during this input period may need to be paid out of pocket and sent in for re-imbursement once all systems are set up.

Can I get a 15th of the month effective date?

Yes.  Carrier specific enrollment packets need to be received 15 days prior to the requested effective date.  Same guidelines apply as those requesting a first of the month effective date.  The closer to the requested effective date that we receive the enrollment packet the later the eligibility will show up in the system.

Who qualifies as an employee?

An employee must work at least 30 hours per week for the employer.

Individual Coverage Questions

What do the acronyms for the products on the premium statement for my SBOTIT coverage represent?

  • AETNHDB - Aetna Hospital Daily Benefit Plan
  • DENTAL – Dental Insurance
  • EMPLIFE – Employee Life Insurance
  • LTD030 – Long Term Disability - 30day waiting period
  • LTD090 – Long Term Disability - 90 day waiting period
  • LTD180 – Long Term Disability - 180 day waiting period
  • MEMLIFE – Member Life Insurance
  • PAI – Personal Accident Insurance
  • OFFOVER – Office Overhead

What is a Hospital daily benefit plan?

The hospital daily benefit plan is an additional hospitalization benefit and is separate from a health insurance plan.  The plan pays a daily amount for each day you or a family member is confined to the hospital.  If you’re in the intensive care unit or receiving inpatient cancer treatment, the daily benefit doubles automatically.  There is no deductible to meet and you may spend the money any way you wish.

What types of individual insurance coverage does the State Bar of Texas Insurance Trust (SBOTIT) and SBIT Insurance Agency, LLC. offer?

We offer Individual health insurance for attorneys and their families, hospital daily benefit, dental, term life, long term disability, personal accident insurance, and office overhead.

How far in advance can you request an individual health quote?

Individual quotes can be requested up to 60 days in advance.

How long is the underwriting process for life/disability products?

Approximately 6 weeks.

Who is eligible for SBOTIT life insurance coverage?

Attorneys, Employee’s and their dependents.