As politicians in Washington continue to figure out how to lower health costs by providing the uninsured with coverage, local officials have been busy putting a solution into action.
TexHealth, a health benefits program developed under the Brazos Valley Council of Governments, recently was launched in the Brazos Valley as a way of offering small business employees low-cost medical care, organizers said.
Anthony Moore, program manager for TexHealth Brazos Valley, said the plan was developed when he and others recognized a need for affordable coverage among low-wage residents.
In Brazos County, 36 percent of adults ages 18 to 64 are uninsured, the highest rate in the region. The lowest rate is in Washington County, where 23 percent of the adult population is uninsured.
"We found out many small business would like to offer health insurance plans, but couldn't because the premiums were too high," he said. "TexHealth was launched and designed to offer affordable coverage. It's a program that's pretty comprehensive, but it is a a limited plan."
Funded by employers and employees, as well as public and private sectors, the program aims to reduce the costs related to unnecessary hospitalizations by focusing on primary and preventative care that promotes early treatment, Moore said.
Premiums are $250 per employee, he said, and the employer is asked to cover half of that. Premium subsidies are available to both owners and employees through TexHealth. As a result, Moore said in many cases the employee could be asked to pay as little as $25 a month, and the employer $75.
Up to $500,000 in health costs are covered, and benefits in the plan include: 12 primary visits a year; impatient hospitalization up to $75,000 annually and $250 a visit; outpatient hospitalization up to $150 per admission; outpatient pharmacies up to $1,200 per year; maternity visits, wellness visit; and up to six outpatient mental health appointments each year.
Dependents of employees are not eligible for the plan, and any costs exceeding the coverage offered have to be paid for by the employee.
Providers under the plan include the St. Joseph Regional Health System and physicians and clinics part of the Alliance Health Providers of the Brazos Valley.
TexHealth enrollment started in August and already has four local businesses on board, Moore said, adding that the goal is to have at least 500 people enrolled in the first year.
The owners of Edible Arrangements were the first to sign up for the five-year pilot program.
Matt Ward, co-owner of the local fruit arrangement shop, also works as an insurance agent, allowing him to provide an expert perspective for the business and his two employees.
"It just made it a lot easier for the people that worked for us to get coverage in a time when premiums are so high and normally they'd be paying around $500 in premiums," he said. "For a small business that's trying to watch its costs, I think it's a great opportunity to offer an extra benefit that most small businesses can't offer."
Dr. Stephen Tseng, who owns a private practice and serves as medical director for TexHealth Brazos Valley, said he offered support for the program because it's different than those he's seen in the past in that it keeps everyone involved responsible for costs, including the patient.
Because the coverage is limited, TexHealth officials encourage patients to educate themselves on their needs, and to shop around for doctors or medical services to keep their costs low, he said.
Tseng said covered patients are eligible for one free doctor's visit a year, another benefit of the program. During that visit, the doctor providing care will be asked to tell the patient specific health areas -- such as diabetes or high cholesterol levels -- he or she should keep an eye on, he said.
RSS
Mobile
Daily Emails
Twitter
Facebook
