Get Honest Answers for Your Texas State Health Insurance Questions

As a result of the almost 6 million Texans that have no health insurance, state legislators created a public/private Texas state health insurance program named Healthy Texas to address this situation. The program is designed to make group health plans more affordable for small employers, so they can offer it as a benefit to their uninsured employees.

Healthy Texas

Healthy Texas is a public/private state health coverage program for small business owners and their workers. Its goal is to provide access to small employers to quality health coverage at an affordable price and its target are the uninsured working Texans.

The program operates just like any private health insurance plan, and it works by providing insurance carriers some protection by reimbursing a part of its costs for high value claims. Healthy Texas is designed to reimburse participating carriers for 80% of the medical expense claims made by an individual, if the total claims value in one year is between $5,000 and $75,000. Participating carriers can offer their Healthy Texas medical coverage plans at very affordable rates.

The health plan has a deductible and/or coinsurance and it will provide 100% coverage for claims below $5,000 and above $75,000 up to the annual limit.

To qualify for Healthy Texas, a business should be classified as a small employer. For group health insurance purposes, state law defines a small employer as one that has 2 to 50 eligible employees. An eligible employee may be a partner or independent contractor and works at least 30 hours per week.

An employee is not eligible if he/she is: a seasonal or temporary worker, has coverage from another health plan; has benefit plan coverage in another county; and has coverage under Medicaid or another federal program.

A business owner is also an eligible employee. A husband and wife is counted as 2 separate employees, but one cannot be a dependent of the other.

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