TexHealth is currently enrolling new groups into the Premium Assistance program. Please contact Jim Rodriguez at 512-524-2618 or email jrodriguez@texhealthct.org for more information

If you are a small businesses in Bastrop, Bell, Burnet, Harris, Hays, Lamar, McLennan, Milam, Travis and Williamson counties within the State of Texas, then you may be eligible to enroll in our AFFORDABLE Premium Assistance Program and we'll help your Employees pay the premium on your small group commercial or SHOP plan.

 

 

Afford better coverage, help employees stay healthy on the job and attract and retain top talent.  

Our Affordable Premium Program allows small businesses who qualify the opportunity to offer an attractive employee benefit package that would otherwise not be possible or available to them as a small group.

 

 

Through our Affordable Premium Program model, TexHealth reimburses one-third of the employee premium up to $110 per month.  After the employer contribution, this can amount to a significant savings to the employee of 50% or more.

 

Employers can choose from any group plan option and/or carrier they wish, or they can also shop on the Exchange for a plan that fits their needs.  Some small businesses may also be eligibile for more savings through a tax credit available only through SHOP.  See below for a detailed overview of our Affordable Premium Program.

Required Documentation

 Application & Enrollment Form

 Wage & Tax Statement

 Payroll Register

 Monthly Premium Invoice

 Owner's Tax Return

 Signed Contract

Downloads

(complete & submit online) 

 

  

Contact for More Info

Jim Rodriguez, President & CEO

  Email Jim Rodriguez

  512.524.2618

Premium Assistance Program Overview

HOW IT WORKS

 

  Upon proof of premium payment by employer, TexHealth will initiate reimbursement (through the program) of one-third of the employee premium up to $110 per month.

 

  Click here for an example on how the premium assistance is applied.

ELIGIBILITY

 

  Employer is a small group with 2 to 50 employees.

 

  Business is located within TexHealth service area of Bastrop, Bell, Burnet, Harris, Hays, Lamar, McLennan, Milam, Travis and Williamson counties within the state of Texas.

 

  Employer may enroll in TexHealth at any time during the year.

 

  Employees must reside in the State of Texas and not on Medicaid.

 

  Employees whose annual gross earnings are $60,240 or less are eligible.

GETTING STARTED

 

  Employer meets eligibility requirements for the program.

 

  Employer is in the process of enrolling in any group plan option offered on or off the Exchange.

 

  Employer completes a TexHealth Application and Enrollment Form

 

  Employer provides TexHealth with its monthly payroll register and quarterly Wage & Tax statement filed with the State of Texas.

 

 Employer signs contract with TexHealth and begins submitting monthly Health Insurance invoice and proof of payment for reimbursement.

DISCLOSURES

 

 Funding for the premium assistance comes from the State of Texas and other sources.  The funds from the State of Texas comes through its Fines & Penalties account.  The Fines & Penalties account receives its resources when commercial insurance companies violate Texas insurance rules and are fined or have monetary penalties assessed.

 

 Employers and employees understand there is no guarantee funds will always be available and may not continue indefinitely.

 

 Employers may not benefit from the premium assistance and any group that covers 100% of the employee share of premium is ineligible.

 

 Employees must pay at least $3.00 per month towards their premium.

How do we do it? As authorized by Health & Safety Code Section 75.102, TexHealth Central Texas will “provide health care benefits to the employees of small employers by purchasing or facilitating the purchase of health benefit plan coverage for those employees from a health benefit plan issuer,” either through the Exchange or commercial coverage.

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