New Affordable Employee Health Insurance

Q: As a small business owner I have struggled to find health insurance benefits for my employees that we can afford. Do you have any suggestions?

A: Fortunately, the Texas Department of Insurance (TDI) has developed a new health insurance product called Healthy Texas to help small business owners who would like to provide health insurance to their employees but have not been able to offer it.

For the employer and the employee, Healthy Texas operates like any private health plan. Healthy Texas was developed by the state, but private health insurance companies provide the coverage. Behind the scenes, Healthy Texas uses a state-funded pool to reimburse participating insurance carriers for some of their high-cost health care claims. By leveraging a combination of public and private funds, Healthy Texas builds on the existing employer-based health insurance model.  It is not part of federal health reform or a federal program.

Healthy Texas costs an average of 30 percent less than comparable employer health insurance plans and offers comprehensive benefits.

Even the smallest companies may be eligible. Healthy Texas was designed to help small businesses that have not offered health insurance benefits within the last 12 months. Eligible businesses are those employing between 2 and 50 eligible workers (including the owners) who work at least 30 hours a week, and 30 percent of those employees are paid annual wages of $32,670 or less.

The employer must pay at least half of employee monthly premiums and the employee is responsible for deductibles, co-insurance, and co-pays. Healthy Texas offers several deductible choices.  At least 60 percent of full-time employees without health insurance must enroll in the program.

The Healthy Texas enrollment process is easy and straightforward. An employer should contact one of the two participating providers, UnitedHeathcare and Celtic Insurance, and submit a short verification form that determines eligibility and allows a rate quote to be generated. Rates are determined only by business location and employees’ ages and genders, not by the medical history of a firm’s employees. Once an employer makes a decision about purchasing a Healthy Texas plan, the employer completes a more detailed application form.

For more information visit the TDI Healthy Texas website, www.healthytexasonline.com, or call 1-800-252-3439. Or visit the website of one of the participating providers, Celtic Insurance at www.myhealthytexas.com, or UnitedHeathcare at www.healthytexasuhc.com, to learn more about available plans, what they cost, and how to enroll.