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Texas Health Insurance (TX)

Texas Health Insurance

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Texas (TX)
Individual Health Insurance Regulations

Learn more about Texas Individual Health Insurance

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

Insurance regulations for the state of Texas permit the use of medical underwriting on all individual insurance products. This allows carriers an opportunity to review past and present medical history for all applicants. Based upon the information obtained during this review, insurance carriers may opt to provide health insurance coverage under the terms of the health plan; or provide modified coverage, citing specific limitations, exclusionary periods or the attachment of an elimination rider, or even deny coverage. When issuing non-HMO individual products to individual slacking 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 coverage for a specific medical condition or ailment, are permitted to be used with both HMO and non-HMO individual health products. HMO plans are exempt from the use of pre-existing condition exclusionary periods. Texas insurance regulations allow grandparents to include their grandchildren on their policy as dependents, as long as the grandchildren reside with the grandparents and are under the age of 25.

Texas (TX)

Small Group Health Insurance Regulations

Pursuant to the Portability and Accountability Act of 1996, all small group plans within the state of Texas is offered on a guarantee issue basis if offered to employee groups of 2- 50 people. Guarantee issue coverage provides that no employer group or individual employee may be declined coverage due to past or current medical 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. Insurance companies may charge different premiums to small groups based on certain underwriting criteria, but the small group premium rates may vary no more 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 exception of late enrollees, an affiliation period may not exceed 2 months. Small group health plans in Texas are also guaranteed renewable, so theinsurance company may not refuse to renew your coverage based on excessive claims from the members of the group plan.

COBRA and Continuation Coverage

Groups with 20 or more employees must abide by federal COBRA regulations which state that a departing employee is entitled to remainon the group health plan for a period of 18 months, provided that group health plan remains in existence. An employee who has left work on his own 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 not subject to federal COBRA regulations because they have fewer than 20employees. Under this state COBRA rule, small groups must provide allow qualified beneficiaries to remain on the group health plan for up to 6months after the termination date of employment. Any person accepting their COBRA option will be responsible for the monthly payment of theinsurance premium, as well as a 2% administration fee. To qualify, an employee must have been insured under the group plan for at least 3months and must accept their COBRA option within 31 days of termination of coverage under the group plan. For groups of 20 or more, COBRA isavailable for up to 18 months under federal laws. Once a person has exhausted their 18 month federal COBRA option, they may apply for an additional 6 months of coverage under state COBRA, providing them with acombined 24 months of COBRA continuation coverage. The Texas Risk Pool provides guaranteed issue individual health insurance for persons that have exhausted their COBRA options and are not qualified for standard issue individual coverage.

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Additional Texas Resource

  • Texas Children's Program - (CHIP)

    The State of Texas has created a program for families who do not qualify for Medicaid but who cannot afford to purchase coverage for their children under 18 on their own. This program offers comprehensive health care benefits to all eligible participants.more...

  • Texas Health Insurance Risk Pool - (THIRP)

    Created by the Texas Legislature to assist high risk individuals obtain health care coverage, the Texas Health Insurance Risk Pool is a cost effective health care plan for Texas residents in need of medical insurance coverage.more...

  • Texas Health and Human Services Commission

    Manages the Texas Medicaid program that provides medical coverage to low-income residents of the state.more...

TX Medical Insurance Statistics


Total Population: 23,406,068
With Health Insurance: 17,573,184 / 75.1%
Without Health Insurance:5,832,884 / 24.9%
*According to the Census Bureau's March 2007 and 2008 Current Population Survey (CPS: Annual Social and Economic Supplements).

Note: The percentage of Texas residents without health insurance has increased .8% since 2004. Texas remains among the states with the highest percentage of uninsured residents.

Texas Department of Insurance
Phone: 800-252-3439
Rich with history, the Texas Department of Insurance dates back to the late 1800's. The department's current focus is to regulate the insurance industry throughout the state, while offering consumer protection and education to the residents of Texas.