With the announcement to districts by the Texas Schools Health Benefits Program ( TSHBP) that member districts must pay an additional monies per employee per month (PEPM) that are enrolled in the program, many member districts are rethinking their membership in the program. Unfortunately, they may be up against an imminent deadline. TSHBP requires districts to tell them by May 1 if they wish to opt out of the program.
In looking at claims data on several TSHBP groups it appears claims are being dragged out beginning March 2024. Of course only TSHBP or their customers know for sure but as independent benefits consultant Bill Rusteberg with RiskManagers.us said “when paid claims per month halve overnight, either it’s purposeful claim dragging or it’s exposure to Magic Dust…”
Rusteberg says “All the signs of a disaster are here. Yet we hear very little from TSHBP. They canceled their regional meetings last month after advertising free food and gifts for attendees.”
Additionally, according to Rusteberg, the May deadline may not be enforceable according to Texas law. For more details he can be reached at:
Bill Rusteberg: riskmanager@sbcglobal.net or by phone at 956-371-4583.
Some think districts have been placed between a proverbial “rock and a hard place” by TSHBP. Many are considering alternative options like cash payment plans LIKE Asserta Health or praying that TRS suspends the five-year membership prohibition and let’s them back in.
This second option simply replaces one PPO for another and does little to help unless the state steps in to heavily subsidize the system. At a time when districts are dealing with double digit inflation and a Legislature and Governor that refuses to fund them adequately, this is the last thing they need!
| Charles Luke Ed.D. – charlesluke43@gmail.com – 940-768-8594 |
