Know your options

Texas Individual Health Insurance

Health insurance is an essential protection that no person or family should be without. As the costs for healthcare continue to increase, shopping for health insurance can be quite perplexing. If you don't get group health insurance through your employer, then you should look into purchasing a Texas individual health insurance from a private insurer. Finding out more about the rules and regulations regarding these individual health insurance plans in Texas is your first step to deciding if this option is right for you.

Eligibility: How Am I Evaluated?

Texas individual health Insurance applications are reviewed based on factors determined by the insurer. There are no Texas laws that regulate how an application should be reviewed. Additionally, an applicant can be denied coverage for any reason, as there are no Texas regulations regarding who should or should not be granted coverage.

In accordance with HIPPA Group-to-Individual Portability Coverage regulations, Texas state guarantees acceptance into the Texas Health Insurance Risk Pool for those who are HIPPA eligible, but have been unable to obtain coverage through a private health insurer.

Texas Guaranteed Benefits & Pre-Existing Conditions

Under Texas law, insurers must have at least one available plan that covers all benefits mandated by the state; these benefits include mammograms, screening for prostate, cervical, colorectal and HPV cancer, coverage for certain diabetic treatment, newborn hearing screening, continuity of care for pregnant women and childhood immunizations. There are also plans known as Consumer Choice Benefits Plans that are lower in cost and therefore do not cover these state mandated benefits. It is important to realize which of these plans you are purchasing when buying a policy. Individual Texas health insurance policies are guaranteed renewable in the state, which means insurers cannot cancel a policyholders plan because they become sick. Texas health insurance law also allows grandparents to keep dependent grandchildren on their health plans until they turn 25 years old.

There are several Texas laws and regulations regarding pre-existing conditions wherein HMO policies are not allowed to require exclusionary periods for their customers. Non-HMO policies can place a 24 month exclusionary period on any conditions that you received advice or treatment for within the last 5 years. If no specific conditions are listed, then the exclusionary period can only last 12 months. Finally, non-HMO policies can include any pre-existing conditions on the policy's elimination rider, which will usually exclude that condition from coverage for the life of the policy. If you make a claim for treatment of a specific condition within the first 2 years of your policy, the insurer can look back in your medical history for the past 5 years to determine whether it is something that should have been diagnosed before your policy began. If so, your claim can be denied.

Texas Individual Health Insurance Premiums

Texas individual health insurance premiums are determined at the discretion of the insurer and are usually based on individual factors, such as age, health status, and family size. Your insurer can increase your premiums at renewal, but it must be for an entire group of people. They cannot single you out. For example, if they raise your premium due to age, it must be something that they are doing for all renewals within your age group. There is no dollar limit on how much you can be charged for your initial premium or renewal premiums. Your Texas individual health insurance policy cannot be cancelled by your insurer when it is time for you to renew. Texas health insurance policies are guaranteed renewal, so that you have the choice of whether or not to continue with your policy regardless of your health or age status. However, you must also be willing to pay the new premium imposed by your insurer.

With the hundreds of different individual policy options out there from multiple private insurers, you are sure to find a plan that meets the needs of your family and your budget. Make sure to contact your local licensed health insurance agent/broker to help you find the right policy for you.

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