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If you are searching for ways to lower your health insurance costs and you live in the State of Texas...We, here at HealthInsureCoverage.com, work hard to supply you with the information you need to make an informed decision regarding your health insurance needs and requirements.

• What are your protections when purchasing individual health insurance in Texas?
     If you do not have access to employer-sponsored health coverage, you may want to buy an individual health plan from a private insurer or HMO. However, in Texas – as in most other states – you have limited guaranteed access to individual health insurance in the private market. There are some alternatives to private individual health insurance coverage – such as COBRA coverage, state continuation coverage, and Texas Health Insurance Risk Pool coverage.
• When do health plans have to sell you individual coverage?
     In general, companies that sell individual health plans in Texas are free to turn you down because of your health status and other factors. When applying for individual health coverage, you may be asked questions about health conditions you have now or had in the past. Depending on your health status, insurers and HMOs might refuse to sell you coverage or offer to sell you a health plan that has special limitations on what it covers.
• Persons who are federally eligible are not guaranteed the right to buy individual health coverage from private insurers and HMOs.
     However, they are guaranteed health coverage from the Texas Health Insurance Risk Pool.
• In Texas, newborns, adopted children, and children placed for adoption are automatically covered under the parents’ individual health plan for the first 31 days, if the plan provides coverage for dependents or maternity benefits.
     The health plan may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days.
• In Texas, adult dependents with physical disabilities or mental retardation are able to stay on their parents’ individual health plan after they have reached the age at which the plan usually cancels dependent coverage.
     In order to be eligible, the adult dependent must be incapable of self-support and must be dependent on the policyholder for support. Proof of incapacity must be provided to the health plan within 31 days of reaching the limiting age. The health plan may require that you show it proof of incapacity again in the future, but not more frequently than annually after the 2 year period following the attainment of the limiting age.
• What will your individual health plan cover?
     It depends on what you buy. Texas does not require health insurers and HMOs in the individual market to sell standardized health plans. Health insurers and HMOs can design different plans and you will have to read and compare them carefully. Health plans are required to provide you with written descriptions of their products so that you can compare the differences. Texas does require all individual health plans to cover certain benefits – such as post-delivery hospital stays (if the plan covers maternity benefits) and mammograms. Check with the Texas Department of Insurance for more information about mandated benefits.
• What kind of coverage is offered if you have a pre-existing condition?
  Individual health plans offered by HMOs cannot contain a pre-existing condition exclusion period. Non-HMO individual health plans in Texas are allowed, in general, to exclude coverage for your pre-existing conditions for up to 2 years. However, if the individual health plan does not ask you questions about your health or medical treatment history when you apply for health coverage and it does not exclude a condition by name on your policy, it can only exclude pre-existing conditions for 12 months.
• Elimination Rider.
     A non-HMO individual health plan may also offer you a contract containing an amendment that puts a permanent exclusion on coverage for a health condition, a body part, or a body system. This type of amendment is known as an elimination rider.
• When determining if a claim is for the treatment of a pre-existing condition, an individual non-HMO health plan is allowed to look back 5 years.
     In an individual health plan, the definition of a pre-existing condition is a condition that you actually received care for, as well as one that the insurer thinks that most people in your situation would have gotten care for during the 5-year period before you applied for health coverage. This is called the prudent person rule. In Texas, pregnancy can be considered a pre-existing condition in individual health plans, but genetic information cannot.
• Individual health plans have to give you credit for your prior continuous coverage if your most recent coverage was under a group, government, or church plan.
     The same types of coverage that are creditable in fully insured group health plans are also considered creditable in individual health plans. Coverage is considered continuous if the gap between health plans is less than 63 days. If you have 18 months of continuous creditable coverage, you will not face a pre-existing condition exclusion period.
      If your gap in health coverage was 63 days or more and your most recent coverage was under a group, government, or church plan, you must be given credit for any creditable coverage in effect at any time during the 18 months preceding your application for coverage. This means that although you will have a pre-existing condition exclusion period, it will be shorter than it would otherwise be.
• In the State of Texax, what can I be charged for individual health coverage?
     If you have an expensive health condition, your individual health plan premiums may be very high. Texas law does not prohibit health insurers from charging you more because of your health status. In addition, when you renew your individual health coverage, an insurer can increase your premiums. Premium increases must be applied to all persons in your class and not on an individual basis. A class may be grouped by age, sex, or by each individual health plan product.
• Your health coverage cannot be canceled because you get sick.
     This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of HMO plans, continue to live in the plan service area. Your health coverage may also be cancelled if the insurer or HMO discontinues your health plan or withdraws from the individual market.
  
• Some insurers sell short-term health plans.
     Short-term policies are not guaranteed renewable. They will only cover you for a limited time, such as 12 months or less. If you want to renew coverage under a short-term health plan after it expires, you will have to reapply and there is no guarantee that the health plan will be-reissued at all or at the same price.
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     There are many rules to consider when purchasing individual health insurance coverage in Texas. It is best that you consult with a qualified health insurance professional in your area who understands the many state and federal laws and regulations.

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