Knowing Your Individual Texas Health Insurance Rights

If you do not have access to Texas health insurance group plan, it may be in your best interest to purchase an individual Texas health insurance policy from a private provider. Texas health insurance companies are regulated by the state health insurance commission in order to guarantee insured individuals certain rights regarding their Texas health insurance coverage. The laws also help protect Texas health insurance companies from fraud.

Texas health insurance companies have the right to deny applicants Texas health insurance coverage based on their health condition and other risk factors that they deem appropriate. If a Texas health insurance applicant is denied a policy, he or she can apply for coverage by the Texas Health Insurance Risk Pool. The Texas Health Insurance Risk Pool is in place to help citizens who cannot afford insurance because of high-risk health status, or who cannot obtain Texas health insurance without elimination riders attached. Individuals can qualify for the Texas Health Insurance Risk Pool if they have been turned down by Texas health insurance companies or if they have been diagnosed with cancer, epilepsy, AIDS, heart conditions or any number of other applicable illnesses.

Individual Texas health insurance plans must guarantee that newborns and adopted children are covered for their first thirty-one days under their parent’s Texas health insurance policy. During that period, the Texas health insurance policyholder must formally add the individual to his or her plan. Texas health insurance companies are also required cover disabled children beyond the regular dependent age limit that is typically enforced. A Texas health insurance company will continue to cover a disabled dependent if he or she relies on the parent as his or her sole support source. Documentation must be provided to the Texas health insurance company within thirty-one days of the dependents’ coverage expiration date. Texas health insurance companies will also insure the grandchildren of their policyholders up until they turn twenty-five as long as they are unmarried and fully dependent on their grandparents.

Texas health insurance companies have no requirements regarding standardized health insurance policies, so different Texas health insurance can provide differing amounts of coverage. It is important to compare several Texas health insurance companies’ plans before choosing the one that is best for your financial and medical needs.

All Texas health insurance companies have the right to impose elimination riders on their policyholders. Elimination riders enable Texas health insurance companies to specify particular pre-existing conditions for which they will not cover claims. HMO plans are not allowed to impose pre-existing condition elimination riders or exclusion periods, but regular Texas health insurance policies can impose exclusion periods that last up to two years. If a Texas health insurance company does not discuss your medical history with you prior to issuing you a Texas health insurance policy, the company can only impose one-year exclusion periods. According to Texas health insurance law, a pre-existing condition is defined as any illness or diagnosis for which you received treatment during the last five years prior to initiating your new Texas health insurance policy.

Knowing Your Individual Texas Health Insurance Rights

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