What are the benefits and costs
of the TexHealth Dallas County Plan?

To promote optimum health and cost efficiency the plan will focus on preventative and primary care. This will reduce unnecessary hospitalization, enhance access to effective treatments and encourage healthy lifestyles. The plan is not comprehensive and does not assume the full risk for all healthcare needs. Services must all be within the Parkland Healthcare System and, by referral only, the UT Southwestern network and will include the following:

• Physician/Clinic Visits – up to 20 per year:
• Primary Care Physician/Clinic – $15 co-pay per visit.
• Specialty Care Physician/Clinic – $30 co-pay per visit.
• Psychiatric or Substance Abuse Therapy – $30 co-pay per visit.
• Wellness Visit – One visit up to $150 per year, no co-pay.
• Lab and X-ray – No co-pay.
• Outpatient Hospital Day Surgery – $100 co-pay per event in Parkland, 2 days of service per year.
• Inpatient Hospital – $200 co-pay per stay, $75,000 annual maximum benefit.
• Emergency Room – $100 co-pay per encounter at Parkland, 2 encounters per year.
• Pharmacy – $1,200 per year, 30 day supply from Parkland Pharmacy:
• $10 co-pay for generics and multisource brands.
• $25 co-pay all other brands under $150.
• $50 co-pay all brands $150 or more.
• Emergency Ambulance – 20% co-pay per trip.
• Lifetime Maximum – $250,000.

Gross employee premiums for the next full year are $260 per member per month (PMPM). As a result of a State grant, net premiums for employees earning less than $37,890 per year ($18.22 per hour at 2080 hours per year) but more than $32,490 per year ($15.62 per hour at 2080 hours per year) are only $190 PMPM, of which you should pay at least one-half, or $95 PMPM. In addition there is a Cost-Sharing Account of $80 per month for each employee earning less than $32,490 per year that must be applied to the employee, bringing her/his contribution to only $15 if he/she has elected the premium subsidy, or $95 if the Point-of-Service election has been made. Employees above these limits receive no subsidy, thus you must determine how these costs are to be split between you and the employee. We recommend that each pay one-half.

Small businesses with less than 25 full-time employees may be eligible for Tax Credits as explained in the IRS Press Release that may be found on this website under “News.”