Texas Health Insurance (TX)

Texas (TX)
Individual Health Insurance Regulations

Learn more about Texas Individual Health Insurance

Health insurance is mandatory when it comes to your family'sphysical well-being. In the event of unanticipated circumstances,suitable health coverage can save a great deal of money due to hugemedical bills. Getting a health insurance policy can be quite confusing.You should evaluate your family's medical needs and finances, beforeselecting a policy. If you are resident of Texas, you can choose fromwide range of health insurance alternatives. The Texas Department ofInsurance supervises the regulations under which the Texas healthinsurers can sell private health insurance to individuals and families.

Insurance regulations for the state of Texas permit the use ofmedical underwriting on all individual health insurance products. Thisallows health insurance carriers an opportunity to review past andpresent medical history for all applicants. Based upon the informationobtained during this review, insurance carriers may opt to providehealth insurance coverage under the terms of the health plan; or providemodified coverage, citing specific limitations, exclusionary periods orthe attachment of an elimination rider, or even deny coverage. Whenissuing non-HMO individual health insurance products to individualslacking prior creditable coverage, the state of Texas permits carriers a60-month look-back period and 24-month exclusionary period limit onpre-existing conditions. Elimination riders, which may exclude coveragefor a specific medical condition or ailment, are permitted to be usedwith both HMO and non-HMO individual health products. HMO plans areexempt from the use of pre-existing condition exclusionary periods.Texas insurance regulations allow grandparents to include theirgrandchildren on their policy as dependents, as long as thegrandchildren reside with the grandparents and are under the age of 25.

Texas (TX)

Small Group Health Insurance Regulations

Pursuant to the Health Insurance Portability and AccountabilityAct of 1996, all small group health insurance within the state of Texasis offered on a guarantee issue basis if offered to employee groups of 2- 50 people. Guarantee issue coverage provides that no employer group orindividual employee may be declined coverage due to past or currentmedical history. For enrollees lacking prior creditable medicalcoverage, insurance carriers are permitted to exercise a 6-monthlook-back, 12-month exclusionary period on pre-existing conditions.Exclusionary periods may not exceed the 12-month period. Insurancecompanies may charge different premiums to small groups based on certainunderwriting criteria, but the small group premium rates may vary nomore than plus or minus 25 percent of the indexed rate. Standard ratesare based on industry classification, the number of enrolled members,health status and geographic location. An affiliation or waiting periodmay be imposed upon applicants seeking an HMO policy. With the exceptionof late enrollees, an affiliation period may not exceed 2 months. Smallgroup health plans in Texas are also guaranteed renewable, so theinsurance company may not refuse to renew your coverage based onexcessive claims from the members of the group plan.

COBRA and Continuation Coverage

Groups with 20 or more employees must abide by federal COBRAregulations which state that a departing employee is entitled to remainon the group health plan for a period of 18 months, provided that grouphealth plan remains in existence. An employee who has left work on hisown or was terminated from the job is eligible to be covered by COBRA,unless the former employer was fired for gross misconduct.

Texas has a mini-COBRA law that applies to groups that are notsubject to federal COBRA regulations because they have fewer than 20employees. Under this state COBRA rule, small groups must provide allowqualified beneficiaries to remain on the group health plan for up to 6months after the termination date of employment. Any person acceptingtheir COBRA option will be responsible for the monthly payment of theinsurance premium, as well as a 2% administration fee. To qualify, anemployee must have been insured under the group plan for at least 3months and must accept their COBRA option within 31 days of terminationof coverage under the group plan. For groups of 20 or more, COBRA isavailable for up to 18 months under federal laws. Once a person hasexhausted their 18 month federal COBRA option, they may apply for anadditional 6 months of coverage under state COBRA, providing them with acombined 24 months of COBRA continuation coverage. The Texas HealthInsurance Risk Pool provides guaranteed issue individual healthinsurance for persons that have exhausted their COBRA options and arenot qualified for standard issue individual coverage.

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