Text Box: HealthBenefitsTexas.com

Text Box: If you’re a Texan looking for health insurance, you’re home!

 Text Box: Overview of the Health Insurance Environment in Texas For Individuals:  All states are required by federal law to provide a mechanism whereby any individual can qualify for health insurance, regardless of their health condition.  However, different states accomplish this goal in different ways.  In Texas, the health insurance vehicle for people that have serious or expensive health conditions is the Texas Health Insurance Risk Pool (THIRP).  Benefits paid by THIRP are partially funded by premium payers in the pool, and the balance is funded by a premium tax levied by the state of Texas on certain types of health insurance companies.  THIRP is currently administered by Blue Cross/Blue Shield of Texas, and THIRP’s PPO network is Blue Cross’ PPO network.  THIRP offers a minimal variety of plans.  None of the THIRP plans offers a physician co-pay feature, and presently, none of them are health savings account (HSA) compatible.  All THIRP plans offer a prescription card. THIRP should be your immediate choice if you possess a serious health condition.  While not comprehensive, here is a short list of conditions which would cause you to be a THIRP candidate: ongoing cancer, ongoing serious heart ailments, insulin-dependent diabetes, any serious lung ailment, a history of alcohol or drug abuse, serious impairments of the kidney, liver, or intestines, serious neurological disorders, severe muscle or bone disease, and ongoing pregnancy (even though normal maternity benefits are not available through THIRP). As a result of the existence of THIRP, private health insurance carriers issuing health insurance in Texas are free to do business in much the same way as they have for many years.  Carriers are free to decline to issue a policy on an applicant, to raise the rates to allow for a specific condition, or to exclude certain conditions by way of the addition of an exclusions page in the policy.  On surface, this  may seem unpalatable, but the existence of this environment has created a very favorable health insurance pricing climate for Texans that are in reasonably good health—even including some folks that take ongoing maintenance drugs (for conditions like high blood pressure or high cholesterol).  Additionally, the highest quality carriers doing business in Texas “block renew”.  Generally, this means that an insured that has developed a health condition with related claims receives the same price increase on his policy anniversary as an insured who is still in good health and has filed no claims—a very comforting feature to those that become ill.  After all—that’s when you need your policy to perform at its best! For Small Businesses: Any Texas small business with at least two eligible employees (but not more than fifty) can obtain a group insurance plan.  However, there are a few requirements which must be followed by the small employer: - He must pay a portion of the cost of insuring eligible employees (but not dependents); this premium contribution level varies from carrier to carrier, but tends to average 50% to 75%; - He must cause a percentage of his eligible employees to be enrolled in the plan at all times   (carriers are free to determine their own percentage requirement; most require 75%). In Texas, there is never any doubt as to whether a carrier will issue a group plan to a small business that meets the preceding requirements.  However, any group carrier is free to charge additional premiums above its stated minimum quotation (a “rate-up”), if the carrier identifies serious health conditions present within the group.  The maximum percentage that a carrier can raise its rates over the minimum is 66.67%, and that rate-up is applied to all employees and dependents within the group. Today, small employer plans have the look and feel of large employer plans.  They can be designed a variety of different ways, almost always include maternity and prescription benefits, and cover most conceivable medical impairments.  In many instances, pre-existing condition limitations are waived for individuals that possessed previous coverage just prior to entering the group plan.  However, group insurance can be an expensive commodity, especially for companies that cover fewer than five employees.  Care must be taken to pick the right carrier and plan design to meet the small employer’s needs.  As opposed to individual insurance, this degree of specialty lends itself to a tailor-made approach. Click here for information on a group plan for a small business Click here for information on THIRP Click here for information on private health insurance for an individual or family