Texas Health Insurance Guide
There are many types of
health insurance coverage plans that are sold in Texas that provide coverage for routine visits to
health care providers, prescription drugs and hospitalization.
Health Insurance Resources for
TX State Residents
Texas residents have access to a variety of health insurance plans and programs. The following information will help you understand what health care insurance options are available in Texas.
Health care insurance in Texas can be divided into four basic categories:
- Health Care Coverage for Individuals and Families
- Health Care Coverage for Small Businesses (2 – 50 employees)
- Health Care Coverage for Mid-size and Large Business (over 50 employees)
- Supplemental Coverage for Individuals with Medicare
Health plans in Texas can be further categorized as state mandated or consumer choice. State-mandated plans require minimum features and coverage. Consumer choice plans can exclude some state mandated benefits (e.g., complications of pregnancy), which generally results in a lower premium.
Individual Health Care Insurance in Texas
If you do not receive insurance through your employer or your spouse or domestic partner’s employer, you can purchase health insurance in Texas directly from an insurance company or HMO to cover you and your dependents. Health insurance for individuals usually costs more than employer-provided group plans and may not provide as much coverage. The insurance provider has the right to consider your medical history and pre-existing conditions, and can deny coverage or offer plans with exclusionary riders. Individual health coverage plans available include:
- Managed Care Plans. Sold as HMOs, HMOs with Point of Service Options and PPOs, these managed care plans keep costs down by requiring you to use their specified network of providers. Depending on the plan, you may need to get pre-authorization to go out of network. In most instances, going out of network means less coverage benefit to you.
- Major Medical Policies. Sometimes offered as Preferred Provider Policies (PPOs), these provide comprehensive coverage for health care services and hospitalization. Depending on your plan, you may be expected to use the preferred network of providers or be reimbursed at a lesser rate (if at all) for going outside the network.
- Hospital Indemnity Polices. These pay up to a fixed amount for every day you are hospitalized.
- Specified or Dread Disease Policies. Sometimes offered as a rider to other individual plans, these pay only for costs associated with the specific condition (e.g., AIDS, heart disease, cancer) named in the policy.
- Short Term Policies. These are available to fill the gap if you have lost coverage temporarily but expect to get it back. Typically they are sold for a set amount of time, not to exceed 12 months.
Small Business Health Care Insurance in Texas
If you are a small business owner looking for health care coverage in Texas, under the state’s insurance law, the number of eligible employees rather than the total number of employees determines whether your business qualifies as a small business. Eligible employees are those who work a minimum of 30 hours each week, are not considered part-time, seasonal or temporary and are not already covered by another group health plan. If you are the owner, you count toward the employee total. Texas law extends benefits in the form of added protection to small businesses. These include a 15% annual cap on rate increases related to health factors, a guarantee against arbitrary discontinuation of coverage and the ability for small employers to pool together to negotiate more favorable rates. Small employers can offer a wide array of plans combining different features and benefits. Small businesses must make insurance coverage available to all eligible employees, but cannot force any employee to participate in a health plan as a condition of hiring or exclude any employee because of age, medical condition, medical history or other health risk factors.
Texas recently enacted a new statewide health insurance program, Healthy Texas, to benefit small business owners and their employees. The program uses a state-funded pool to pay for above average health care claim costs while letting enrollees choose from an approved number of plans selected by TDI through competitive bidding.
Large Business Health Care Insurance in Texas
Under Texas law, mid- and large-sized businesses have more flexibility in determining how a health plan is offered to employees. The law also makes fewer requirements for specific coverages a plan must include. Significantly, firms with more than 50 employees may opt to offer health care coverage as a benefit to a designated class of employees based on length of employment, pay grade or similar non-discriminatory criteria.
Coverage through the Texas Health Insurance Pool
Although the premiums can be expensive, the Texas Health Insurance Pool provides coverage if you are a Texas resident and unable to obtain insurance from licensed private insurers because of your health or a pre-existing condition.
Compare free Texas health
insurance quotes and coverage plans.
Texas Department of Insurance
P.O. Box 149104
Austin, TX 78714-9104
Phone: (512) 463-6169
http://www.tdi.state.tx.us/
Texas Department of State Health Services
1100 West 49th Street
Austin, TX 78756
Phone: (888) 963-7111
http://www.dshs.state.tx.us/
Texas Health and Human Services Commission
The Health and Human Services Commission (HHSC) provides leadership and direction, and fosters the spirit of innovation needed to achieve an efficient and effective health and human services system for Texans. http://www.hhsc.state.tx.us/about_hhsc/index.shtml
Texas Medicaid Program
http://www.hhsc.state.tx.us/medicaid/med_info.html
Texas Health Insurance Premium Payment Program, HIPP
http://www.hhsc.state.tx.us/medicaid/programs/hipp/hipp_start.html
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/