Cash Pay Health Plans for Texas Employers: How $0 Coordinated Care Works

A cash pay health plan gives employees a dedicated primary care team at $0 and pays for coordinated outside care, like specialists, imaging, labs, and surgery, at a price agreed upfront, so most coordinated care costs the employee $0. Care that is not coordinated falls back to normal copays and deductibles. That is the core of a cash pay health plan for employers, and it is available to Texas groups with 20 or more employees.

Owners keep hearing that a richer plan means a bigger premium. This model flips the order. A primary care team sits inside the plan at $0, sets up everything else at a cash price agreed before the visit, and the plan pays the provider directly.

How a cash pay health plan for employers works

A standard plan pays for care after the fact. The provider bills a claim, the carrier processes it, and weeks later the employee gets a bill for whatever the deductible or coinsurance left over. A coordinated care health plan reverses that order. The care team picks the provider, settles the price, and the plan pays at the time of service.

For coordinated care there is no deductible to meet and no copay first. That is first dollar coverage, and it is how cash pay healthcare for employees can mean lower out of pocket costs for employees in Texas.

What stays the same for employees

Employees still get primary care, specialists, medications, imaging and labs, urgent care, hospital care, and emergency care. What changes is the route, not the coverage list. The employee starts with a text to the care team instead of booking on their own.

Access stays open. Employees are not limited to a short list of approved doctors. An employee can name a doctor they like, and the team confirms pricing with that office.

The two pieces: a primary care team and coordinated care

The first piece is a direct primary care team. The employee texts that team first. Visits are unlimited, in person or virtual, at $0. The team also supports sleep, nutrition, exercise, and mental health.

The second piece is coordinated care. When the employee needs something outside the team, the team arranges it: specialist visits, labs, imaging, surgeries, specialty medications, cancer care, chronic condition management, hormone health and menopause care, at home sleep studies, and more.

What employees pay when care is coordinated vs when it is not

Type of care	What the employee pays
Preventive care (screenings, immunizations)	$0
Primary care team visits, in person and virtual	$0, unlimited access
Telemedicine (messaging, phone, video)	$0
Specialists or primary care outside the team	$0 when coordinated
Urgent care	$0 when coordinated
Lab work	$0 when coordinated
X rays and ultrasounds	$0 when coordinated
CT scans and MRIs	$0 when coordinated
Prescriptions on the free drug list	$0, delivered to the home
Generic drugs not on the free list	$15 copay when coordinated
ER and hospital care	$500 copay
Any care not coordinated by the team	Normal copays, deductibles, and other cost sharing

Two rows matter most. ER and hospital care carry a $500 copay. Care arranged without the team falls back to normal out of pocket costs. The $0 only applies when the team sets it up, and exact amounts and visit limits vary by plan.

How the cash payment works, step by step

1. The employee texts the care team with what they need.
2. The team picks the provider, or confirms the one the employee named, and agrees on the price with that provider upfront.
3. The team sends a virtual card, funded by the health plan, to the employee's phone.
4. The employee pays at the visit as self pay. They do not show an insurance card.
5. The employee sends an itemized receipt. A credit card receipt works in the meantime.

If the provider recommends more care during the visit, the employee messages the team with the service and cost, and a new card can be issued.

Why a cash price can cost less than a claim

Providers often charge less when the price is agreed upfront and paid at the time of service. A claim takes work to collect: billing, waiting, and sometimes prior authorization. Paying directly removes those delays. Whether it lowers your plan cost depends on how employees use care and which design you pick.

Two ways to set it up: bolt on or all in one

Bolt on is the lighter option. You keep a major medical group plan, often a higher deductible design, with your current carrier and add the $0 primary care team plus free generic mail order meds. The major medical plan still handles imaging, hospital, ER, and major procedures. For many groups, that is where we would start.

All in one is direct primary care with a level funded plan or a self funded one, where the coordinated cash pay layer also covers specialists, imaging, labs, surgeries, hospital stays, and ER. See self funded vs level funded for how the risk differs.

Either way, it works alongside your existing setup without a full benefits overhaul. You also get a clinical lead who runs population health strategy and quarterly reporting on engagement, care gaps, chronic conditions, high risk outreach, and medical and Rx claims.

What it looks like when an employee needs care

Cold or flu: text the team, get a phone or video visit, and the prescription goes to a nearby pharmacy.

Generic refill: text the team, and it is delivered to the home.

Chest pain that is not an emergency: text the team, get a video visit, records are shared, and the team coordinates follow up.

True emergency: go to the ER or call 911 first, then text the team afterward.

The trade offs to know before you switch

The coordination rule is the big one. Care booked without the team falls back to normal copays and deductibles, and ER and hospital care still carry a $500 copay. Each employee downloads the messaging app, creates an account with their open enrollment information, and completes a health intake form.

Plan details and visit limits vary by plan. On level funded designs, enrollment and underwriting rules still apply, including 75% participation and 50% contribution carrier rules. Most of all, it only pays off if employees use the team. If your goal is just removing the deductible, compare zero deductible group health insurance.

How we quote it next to a regular group plan

We run the cash pay design side by side with a standard group quote from the same census. We quote all major carriers and several regional ones. It is available for groups with 20 or more employees, and coverage can start on the 1st of any month. It fits well when you are facing a renewal increase.

For context, our published 2026 full single premium runs about $625 to $680 per employee per month, about $313 to $340 for the employer at 50%. See group health insurance cost in Texas. PEPM is built into the premium; on level funded quotes we set it inside the monthly payment. Read our 40 Google reviews.

Frequently asked questions

Is a cash pay health plan the same as having no insurance?

No. A cash pay health plan for employers sits inside an employer health plan. It is either added to a major medical group plan that still handles hospital, ER, and major procedures, or built into a self funded or level funded plan. The cash part describes how coordinated care gets paid: at a price agreed upfront, with a plan funded virtual card.

Which Texas employers can offer a cash pay health plan?

Groups with 20 or more employees can offer it. Smaller groups are not eligible for this design. Coverage can start on the 1st of any month. On level funded designs, enrollment and underwriting rules still apply, including carrier participation and contribution requirements. We quote it side by side with a standard group plan from the same census so you can compare both before deciding.

What happens if an employee skips the care team?

Care that is not coordinated by the team falls back to normal out of pocket costs, meaning copays, deductibles, and other cost sharing under the plan. The $0 amounts only apply when the team arranges the care and confirms the price first. In a true emergency, the employee goes to the ER or calls 911 first, then texts the team afterward.

Can employees keep their own doctor?

Usually, yes. The model uses open access, so employees are not limited to a short list of approved doctors. An employee can name a doctor they like, and the care team contacts that office to confirm pricing before the visit. If the price is agreed, the plan funded virtual card pays it. Actual coverage and visit limits vary by plan.

The short answer

A cash pay health plan gives employees a $0 primary care team and pays for coordinated specialists, imaging, labs, and surgery at a price agreed upfront, so most coordinated care costs the employee $0. Care that skips the team falls back to normal copays and deductibles, and ER and hospital care carry a $500 copay. It is available for Texas groups with 20 or more employees.

Compare a cash pay plan with your current renewal

Send us your renewal and census, and we will run a cash pay design side by side with a standard group quote. Book a benefits review.

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