Texas Health Insurance Regulations
Texas has laws that address health insurance and the coverage options that are available. Texas does not have specific laws that address the cost or availability of insurance that is provided in the state. Health insurers do have to follow the laws that regulate health insurance providers and policies.
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Disabilities or Medical Conditions
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Texas does not allow the use of a person's disability as the only reason for declining or charging a higher premium for coverage. This does not apply if the insurer can show that the disability can increase the risk of filing a claim. If a pre-existing exclusion is applicable, it needs to apply equally to members of a group insurance plan. This includes health plans offered by an employer.
Coverage for Seniors
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Texas does not have many laws that address insurance coverage for older residents. People ages 50 to 64 might find obtaining a health insurance policy extremely difficult. Coverage might be available from an employer. If an employer has a group health insurance plan, the rules for the plan need to apply equally to all group members regardless of age or medical condition. The same rules apply for other group health plans such as those for a trade union or professional organization.
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Coverage for Children
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One program that is available in Texas as well as other states is the Children's Health Insurance Program (CHIP). This is a state and federal health coverage program for individuals and families that cannot qualify for Medicaid because they make too much money. A family that participates in the program pays a small fee to cover all of the children that need to be in the plan. The plan requires re-enrollment every year.
Coverage for Unemployed
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Individuals that become unemployed in Texas can have the option to continue on their former employer's group health insurance plan. Texas law, as well as the federal COBRA law, allows a recently unemployed worker to continue this coverage. Federal and state laws require an employer to provide all information about an individual's right to continuation of health coverage. A notice must be sent within 30 days after a worker is no longer employed. A decision to continue coverage will need to be made within 60 days after receiving the notice.
Texas Health Insurance Risk Pool
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Texas offers a health pool program for residents who are unable to obtain an individual health insurance policy because of health issues. Certain qualifications must be met to qualify for the health pool, including being rejected for other types of health insurance policies, being unable to find health insurance without certain coverage excluded or being automatically disqualified because of a specific health condition.
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