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The thing that kills me about this deal is these people took the owner off a major medical plan and put them on this crappy limited plan that does not look like it is even funded ....that should be against the law....and lets talk about misleading info on who's paying claims ....United is doing the administration of the plan but not using company money to pay these claims........
So if you live in Texas and someone tries to sell you this limited piece of garbage saying you can not afford real insurance then they are lying to you. Research all your options with a licensed health insurance broker from individual major medical health plans to true group major medical health plan. You might be surprised how affordable it can be. If you do not have a insurance broker than feel free to call or email me for all your options at 512-260-0856 [email protected].
statesman.com
Low-cost plan for uninsured workers launches[UTUWUcUcUZUbU[UcTYWYWZV&urcm=y
Coverage is for workers at companies that employ 50 people or fewer in Travis, Hays and Williamson counties.
By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Saturday, August 01, 2009 For 10 to 15 years, the owners of Myers Concrete Construction in Wimberley hunted around for health insurance to cover their workers, but they couldn't find an affordable plan.
"We lost a really great guy because he went with another company that had health insurance," company President Charlene Myers said. She feared the man's wife would be next out the door.
Today, Myers' company will become the first to sign up with TexHealth Central Texas, a new health-benefits plan that aims to cover 2,500 workers in Travis, Hays and Williamson counties in the next three years.
Today, Myers' company will become the first to sign up with TexHealth Central Texas, a new health-benefits plan that aims to cover 2,500 workers in Travis, Hays and Williamson counties in the next three years.
The plan, which is for companies with 50 or fewer employees, launches today with start-up help from three government bodies. During the next few weeks and months, Jim Rodriguez, president and CEO of the plan, and others will be spreading the word about it.
The Travis County Healthcare District, which has for several years been promoting the idea of creating a low-cost health insurance plan for small businesses as a way to reduce the growing ranks of the uninsured, contributed $339,450 to get the program started and to help cover administrative costs, Rodriguez said. The Williamson County Commissioners Court approved $80,000, and Hays County commissioners on Tuesday are expected to add $32,550, Rodriguez said.
Doctors in the Choice Plus network of United Healthcare will provide the services, and United will pay the claims for people in the plan.
The employee and the employer each pay an average of $122 in monthly premiums — dependents aren't covered — and the annual deductible is $250. Co-pays for primary care are $20 and specialty care visits are $40, while the limit on drug benefits per year is $1,000, and for hospitalizations, it's $100,000.
"It looks like it's going to be great," said Myers, 47. "I'm a little bit concerned about the $100,000 (limit) ... but I have a very high deductible, so I'm going to be switching to this."
So is her 51-year-old husband, who works at the company, she said. In all, 11 of the 13 eligible employees at Myers' company have signed up, Rodriguez said.
The program also is pursuing $1 million in federal grants from the U.S. Department of Health and Human Services, and if the money is awarded, it will be used to reduce certain employees' premium share, he said.
Texas has the nation's highest rate of uninsured residents — 1 in 4. One in 5 Travis County residents lack coverage and 70 percent of the participants in TexHealth Central Texas are expected to be Travis County workers.
Clarke Heidrick, a member of the Travis County Healthcare District board who has pushed the idea almost since the district's inception in 2004, said "it's not a Cadillac but it's a good basic program."
He's pleased to see the plan come to fruition, even though it won't cover the 10,000 workers initially envisioned. He hopes it will prove itself and grow.
The government bodies will be asked to contribute for two more years. After that, the program is expected to be self-sustaining, said Christie Garbe, spokeswoman for the health district.
Although Congress and the Obama administration are working on a plan to cover more uninsured Americans, it doesn't take long for a serious illness to financially devastate a person, Rodriguez said.
"No matter what the reform package turns out to be, it's not going to be enacted until 2013 or 2014," Rodriguez said. "What do you do in between?"
There are now six such low-cost small business plans in Texas, said Rodriguez, who is executive director of a similar health benefits program in Galveston.
"If (small business employers and employees) want a health benefits plan that's not going to cost them an arm and a leg, and that's weighted toward preventing illness," he said, "they're not going to go wrong."
the plans site.....
TexHealth Central Texas Benefits Plan Summary
TexHealth Central Texas Benefits Plan Summary
Benefits Plan Annual Calendar Year Deductible $250 Member Share (Co-insurance) 20% Out of Pocket Maximum (Including Deductible and Co-insurance) $5,250 Annual Calendar Year Maximum Hospital Benefit per Person $100,000 (Inpatient & Outpatient) Hospital Benefits All Hospital Benefits are Subject to Annual Calendar Year Maximum Benefit for Inpatient and Outpatient Hospital Services Inpatient Hospital Stay Subject to deductible and 20% Member Share (Co-insurance) Outpatient Hospital Surgery Subject to deductible and 20% Member Share (Co-insurance) Hospital Outpatient Rad/Path, Pharmacy and Blood, Cardiovascular, PT/OT/ST, Other Subject to deductible and 20% Member Share (Co-insurance) Emergency Room Visits $250 co-pay Maternity Covered under Inpatient Hospital Physician Benefits in IP / OP Facility Inpatient Hospital Care Subject to deductible and 20% Member Share (Co-insurance) Outpatient Hospital Care Subject to deductible and 20% Member Share (Co-insurance) Radiology, Pathology Subject to deductible and 20% Member Share (Co-insurance) Physician Benefits in Office Physician Office Visit Limit and Co-pays 8 visits covered annually $20 co-pay for Primary Care Visit, $40 co-pay for Specialist Visit Maternity Covered subject to specialty co-pay for initial prenatal visit; not subject to office visit limit Speech/Hearing Exams Included in physician office visit benefits above Physical Therapy $40 co-pay per visit 8 visits covered annually Podiatrist Subject to deductible and 20% Member Share (Co-insurance) Radiology and Pathology Performed in Office Setting Covered under office visit co-pay when performed in association with covered office visit for preventative services Non-preventative subject to deductible and 20% Member Share (Co-insurance) Miscellaneous Medical Services (Includes Therapeutic Injections, Allergy Testing, Allergy Immunotherapy, Cardiovascular, and Immunizations) Covered under office visit co-pay when performed in association with covered office visit Psychiatric and Substance Abuse Services All Hospital Benefits are Subject to Annual Calendar Year Maximum Benefit for Inpatient and Outpatient Hospital Services Inpatient Subject to deductible and 20% Member Share (Co-insurance) Limited to 60 days per calendar year Outpatient $40 co-pay per visit Limited to 10 visits per calendar year Other Services Prescription Drugs $15/$35/$50 Retail, $1,000 Plan Year Maximum Benefit Ambulance Subject to deductible and 20% Member Share (Co-insurance) Home Healthcare Subject to deductible and 20% Member Share (Co-insurance) Durable Medical Equipment Subject to deductible and 20% Member Share (Co-insurance) Medical Supplies 20% Member Share (Co-insurance) $1,000 Calendar Year Maximum Benefit Out-of-Network Benefits Covered for Emergency Care Only - $250 co-pay
So if you live in Texas and someone tries to sell you this limited piece of garbage saying you can not afford real insurance then they are lying to you. Research all your options with a licensed health insurance broker from individual major medical health plans to true group major medical health plan. You might be surprised how affordable it can be. If you do not have a insurance broker than feel free to call or email me for all your options at 512-260-0856 [email protected].
statesman.com
Low-cost plan for uninsured workers launches[UTUWUcUcUZUbU[UcTYWYWZV&urcm=y
Coverage is for workers at companies that employ 50 people or fewer in Travis, Hays and Williamson counties.
By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Saturday, August 01, 2009 For 10 to 15 years, the owners of Myers Concrete Construction in Wimberley hunted around for health insurance to cover their workers, but they couldn't find an affordable plan.
"We lost a really great guy because he went with another company that had health insurance," company President Charlene Myers said. She feared the man's wife would be next out the door.
Today, Myers' company will become the first to sign up with TexHealth Central Texas, a new health-benefits plan that aims to cover 2,500 workers in Travis, Hays and Williamson counties in the next three years.
Today, Myers' company will become the first to sign up with TexHealth Central Texas, a new health-benefits plan that aims to cover 2,500 workers in Travis, Hays and Williamson counties in the next three years.
The plan, which is for companies with 50 or fewer employees, launches today with start-up help from three government bodies. During the next few weeks and months, Jim Rodriguez, president and CEO of the plan, and others will be spreading the word about it.
The Travis County Healthcare District, which has for several years been promoting the idea of creating a low-cost health insurance plan for small businesses as a way to reduce the growing ranks of the uninsured, contributed $339,450 to get the program started and to help cover administrative costs, Rodriguez said. The Williamson County Commissioners Court approved $80,000, and Hays County commissioners on Tuesday are expected to add $32,550, Rodriguez said.
Doctors in the Choice Plus network of United Healthcare will provide the services, and United will pay the claims for people in the plan.
The employee and the employer each pay an average of $122 in monthly premiums — dependents aren't covered — and the annual deductible is $250. Co-pays for primary care are $20 and specialty care visits are $40, while the limit on drug benefits per year is $1,000, and for hospitalizations, it's $100,000.
"It looks like it's going to be great," said Myers, 47. "I'm a little bit concerned about the $100,000 (limit) ... but I have a very high deductible, so I'm going to be switching to this."
So is her 51-year-old husband, who works at the company, she said. In all, 11 of the 13 eligible employees at Myers' company have signed up, Rodriguez said.
The program also is pursuing $1 million in federal grants from the U.S. Department of Health and Human Services, and if the money is awarded, it will be used to reduce certain employees' premium share, he said.
Texas has the nation's highest rate of uninsured residents — 1 in 4. One in 5 Travis County residents lack coverage and 70 percent of the participants in TexHealth Central Texas are expected to be Travis County workers.
Clarke Heidrick, a member of the Travis County Healthcare District board who has pushed the idea almost since the district's inception in 2004, said "it's not a Cadillac but it's a good basic program."
He's pleased to see the plan come to fruition, even though it won't cover the 10,000 workers initially envisioned. He hopes it will prove itself and grow.
The government bodies will be asked to contribute for two more years. After that, the program is expected to be self-sustaining, said Christie Garbe, spokeswoman for the health district.
Although Congress and the Obama administration are working on a plan to cover more uninsured Americans, it doesn't take long for a serious illness to financially devastate a person, Rodriguez said.
"No matter what the reform package turns out to be, it's not going to be enacted until 2013 or 2014," Rodriguez said. "What do you do in between?"
There are now six such low-cost small business plans in Texas, said Rodriguez, who is executive director of a similar health benefits program in Galveston.
"If (small business employers and employees) want a health benefits plan that's not going to cost them an arm and a leg, and that's weighted toward preventing illness," he said, "they're not going to go wrong."
the plans site.....
TexHealth Central Texas Benefits Plan Summary
TexHealth Central Texas Benefits Plan Summary
Benefits Plan Annual Calendar Year Deductible $250 Member Share (Co-insurance) 20% Out of Pocket Maximum (Including Deductible and Co-insurance) $5,250 Annual Calendar Year Maximum Hospital Benefit per Person $100,000 (Inpatient & Outpatient) Hospital Benefits All Hospital Benefits are Subject to Annual Calendar Year Maximum Benefit for Inpatient and Outpatient Hospital Services Inpatient Hospital Stay Subject to deductible and 20% Member Share (Co-insurance) Outpatient Hospital Surgery Subject to deductible and 20% Member Share (Co-insurance) Hospital Outpatient Rad/Path, Pharmacy and Blood, Cardiovascular, PT/OT/ST, Other Subject to deductible and 20% Member Share (Co-insurance) Emergency Room Visits $250 co-pay Maternity Covered under Inpatient Hospital Physician Benefits in IP / OP Facility Inpatient Hospital Care Subject to deductible and 20% Member Share (Co-insurance) Outpatient Hospital Care Subject to deductible and 20% Member Share (Co-insurance) Radiology, Pathology Subject to deductible and 20% Member Share (Co-insurance) Physician Benefits in Office Physician Office Visit Limit and Co-pays 8 visits covered annually $20 co-pay for Primary Care Visit, $40 co-pay for Specialist Visit Maternity Covered subject to specialty co-pay for initial prenatal visit; not subject to office visit limit Speech/Hearing Exams Included in physician office visit benefits above Physical Therapy $40 co-pay per visit 8 visits covered annually Podiatrist Subject to deductible and 20% Member Share (Co-insurance) Radiology and Pathology Performed in Office Setting Covered under office visit co-pay when performed in association with covered office visit for preventative services Non-preventative subject to deductible and 20% Member Share (Co-insurance) Miscellaneous Medical Services (Includes Therapeutic Injections, Allergy Testing, Allergy Immunotherapy, Cardiovascular, and Immunizations) Covered under office visit co-pay when performed in association with covered office visit Psychiatric and Substance Abuse Services All Hospital Benefits are Subject to Annual Calendar Year Maximum Benefit for Inpatient and Outpatient Hospital Services Inpatient Subject to deductible and 20% Member Share (Co-insurance) Limited to 60 days per calendar year Outpatient $40 co-pay per visit Limited to 10 visits per calendar year Other Services Prescription Drugs $15/$35/$50 Retail, $1,000 Plan Year Maximum Benefit Ambulance Subject to deductible and 20% Member Share (Co-insurance) Home Healthcare Subject to deductible and 20% Member Share (Co-insurance) Durable Medical Equipment Subject to deductible and 20% Member Share (Co-insurance) Medical Supplies 20% Member Share (Co-insurance) $1,000 Calendar Year Maximum Benefit Out-of-Network Benefits Covered for Emergency Care Only - $250 co-pay
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