Swisher Health Insurance

Facts and Figures

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Breakdown of Insureds

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Insurance Carriers

State Government Insurance Programs Offered

Texas Health Insurance Pool (The Pool)

Covers Hospitalizations, Physician care, Pregnancy complications, Prescriptions, drugs, Treatment for serious mental health illnesses, and other services. There are 5 plans to choose from including an HSA-Qualified Plan. There is a 12-month waiting period for people with pre-existing health conditions where the policy will not pay any expenses for the condition. If you were covered by creditable coverage in place during the 12 months before your effective date your wait time will be reduced

Texas employee Group Insurance Program (GBP)

Must be an employee of state agency, higher education institution (except for the University of Texas and Texas A&M University systems), Windham School District, Community Supervision and Corrections Department (CSCD), Texas Municipal Retirement System (TMRS), Texas County and District Retirement System (TCDRS).

Children’s Health Insurance Program (CHIP) www.chipmedicaid.org

CHIP: First time enrollees in CHIP who previously had private health insurance will have a 90-day waiting period for benefits. Exceptions: Children who lost insurance due to parents’ loss of job and/or dependent coverage or change in marital status; children who lost Medicaid eligibility or had prior insurance that cost 10% or more of family income; new children (e.g. newborns) added to current CHIP account. Eligibility: CHIP: Must be a U.S. citizen or legal permanent resident, age 0–18 and live in Texas. Income limit of 101% to 200% FPL. Must have no health insurance for six months prior to time of application.


Medicaid pays for acute health care (physician, inpatient, outpatient, pharmacy, lab, and x-ray services), and long-term services and supports for aged and disabled clients


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Children with Special Health Care Needs (CSHCN)

Ambulances, Ambulatory surgery, Primary and preventive care, Inpatient rehabilitation and outpatient care, Speech and hearing services, Vision and dental care, Family support and mental health, Laboratory and radiology, Equipment and medical supplies, Home health nursing, Hospice and hospital care, Meals, Lodging, Medical transportation and medicines, Occupational and physical therapy, Orthotics and prosthetics, Special nutritional products, Insurance premium payment assistance, and Case management. Must be a Texas resident and either be: A) Younger than 21 years old with a chronic physical or developmental condition that will last for at least 12 months; that if not treated may result in disability; that requires health and related services beyond those required by children generally; and the condition must show physically (body, bodily tissue or organ). Condition must not be only a delay in intellectual development or solely a mental, behavioral, or emotional condition. Or B) A person of any age with cystic fibrosis. Enrollees must keep private health insurance, Medicaid, CHIP, or SKIP coverage all times. CSHCN is the payer of last resort. It will pay only after private or public insurance has been billed.

Indian Health Services (IHS)

Must exhaust all private, state, and other federal programs. Must be regarded by the local community as an Indian; is a member of an Indian or Group under Federal supervision; resides on tax-exempt land or owns restricted property; actively participates in tribal affairs; any other reasonable factor indicative of Indian descent; is a non-Indian woman pregnant with an eligible Indian’s child for the duration of her pregnancy through post-partum (usually 6 weeks); is a non-Indian member of an eligible Indian’s household and the medical officer in charge determines that services are necessary to control a public health hazard or an acute infectious disease which constitutes a public health hazard.

Heath Care Reform

Immediate Benefits for Texas

Small business tax credits. 293,000 small businesses in Texas could be helped by a new small business tax credit that makes it easier for businesses to provide coverage to their workers and makes premiums more affordable.1 Small businesses pay, on average, 18 percent more than large businesses for the same coverage, and health insurance premiums have gone up three times faster than wages in the past 10 years. This tax credit is just the first step towards bringing those costs down and making coverage affordable for small businesses.
Closing the Medicare Part D donut hole. Last year, roughly 237,000 Medicare beneficiaries in Texas hit the donut hole, or gap in Medicare Part D drug coverage, and received no extra help to defray the cost of their prescription drugs.2 Medicare beneficiaries in Texas who hit the gap this year will automatically be mailed a one-time $250 rebate check. These checks will begin to be mailed to beneficiaries in mid-June and will be mailed monthly throughout the year as new beneficiaries hit the donut hole. The new law continues to provide additional discounts for seniors on Medicare in the years ahead and completely closes the donut hole by 2020.
Support for health coverage for early retirees. An estimated 207,000 people from Texas retired before they were eligible for Medicare and have health coverage through their former employers. Unfortunately, the number of firms that provide health coverage to their retirees has decreased over time.3 Beginning June 1, 2010, a $5 billion temporary early retiree reinsurance program will help stabilize early retiree coverage and help ensure that firms continue to provide health coverage to their early retirees. Companies, unions, and state and local governments are eligible for these benefits.
New consumer protections in the insurance market beginning on or after September 23, 2010.
Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 11.8 million Texas residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.
Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 1.1 million individuals who purchase insurance in the individual market from dishonest insurance practices.
Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Texas peace of mind.
Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care. This will protect the 10.6 million residents of Texas with health insurance from their employer, along with anyone who signs up with a new insurance plan in Texas.
Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.
Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.
Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 161,000 individuals in Texas who could now have quality affordable coverage through their parents.4 Some employers and the vast majority of insurers have agreed to cover adult children immediately.
Affordable insurance for uninsured with pre-existing conditions. $493 million federal dollars are available to Texas starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.
Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 318 Community Health Centers in Texas but also support the construction of new centers.
More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 12% of Texas’s population who live in an underserved area.
New Medicaid options for states. For the first time, Texas has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status.

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