Private Exchange

Learn more about this full-service solution for individuals to purchase health coverage through an online marketplace.

Texas Health Insurance Exchange

In July 2012, Governor Rick Perry announced that Texas would not establish an exchange. As a result, the federally-run marketplace will begin open enrollment for individual and small business employers in October 2013.

Texas has the highest percentage of uninsured residents in the country. To ensure they all have the necessary information about the health care reform and its requirements, the Department of Insurance will include health insurance information on its website, including communications related to the federal health exchange.

Essential Health Benefits

The Affordable Care Act requires individual and small employer group plans to cover a minimum package of essential health benefits beginning in January 2014. The essential health benefits package is based on the coverage offered in the most popular plan in Texas’ small group market - the BlueCross BlueShield BestChoice PPO. Health plans must include the following items and services: ambulance transportation and emergency services; hospitalization; maternity and newborn care; mental health and substance abuse services including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services, as well as chronic disease management; and pediatric services including oral and vision care.

Texas Health Insurance Exchange Stats:

  • Total Residents: 25,339,900
  • Total Health Expenditures (in millions): $146,735
  • Exchange Decision: Default to Federal Exchange
  • Total Health Insurance Exchange Grant: $96,425
  • EHB Benchmark Plan Status: Default

Texas will have a federally-run marketplace in October 2013. The essential health benefits package is based on the most popular small group market in the state, the BlueCross BlueShield BestChoice PPO.

For more information about setting up a private exchange solution in Texas, contact a representative at GoHealth today.