Texas Health
Insurance
Texas health insurance
purchases can be very
confusing. There are many
questions to ask as you
compare companies selling
health insurance in Texas
. Even though these
companies’ coverage
options appear different
there are some
circumstances that are
controlled by Texas laws
and regulations and
therefore the same. For
example …
What about pre-existing
conditions?
Let’s
talk about what you need
to know about
pre-existing conditions
before purchasing health
insurance in Texas.
First let’s get
HMO’s out of the way.
This one is simple! In
Texas individual health
plans offered by HMOs
cannot contain a
pre-existing condition
exclusion period. But,
now it gets really
complex…
When determining if a
claim is for the
treatment of a
pre-existing condition,
an individual non-HMO
health plan can look
back 5 years. Non-HMO
individual health plans
in Texas are allowed 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. Okay that
seems simple enough; all
you have to do is read
all of the applications
until you find one with
your pre-existing
condition not listed.
You finally find one, so
you apply! Your new
policy arrives. You
decide to read all of
the fine print and what
do you find? It has an
elimination rider which
is an amendment that
puts a permanent
exclusion on coverage
for a health condition
which pre-existed.
So
this isn’t the policy
for you! As you looking
for another coverage
option, here are a few
things to consider If
you have a pre-existing
condition…
pregnancy
can be considered a
pre-existing condition
in individual health
plans, but genetic
information cannot.
Who do you trust?
This
will make you feel real
comfortable! It’s called
the prudent person rule.
In an individual health
plan, the definition of
a pre-existing condition
is a condition for which
you actually received
care, 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. 63 Days -
where did that come
from?
Individual health plans
have to give you credit
for your prior
continuous coverage if
your most recent
coverage was under a
group plan. Continuous
coverage means 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 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 by the
amount of credit you
earned.
Whew!
Okay you give up yet?
Let
Texas-Health-Insurance-Online.com
help you determine and
negotiate the coverage
that is right for you –
at the best price!
We will read the fine
print for you!
We
are professionals with
solid experience,
dedicated to act in your
best interest. Not only
will we get you the
coverage you need, we’ll
continue to service your
coverage needs,
interpret the policy
fine print and provide
claim processing help as
long as you remain a
client of ours…
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