Texas Health Insurance

The state of Texas has a reputation for keeping a “hands-off” approach to most forms of government regulation, and its stance on health insurance is no exception.  Despite the lax controls, however, it is quite feasible to find good health coverage here if you’re willing to take advantage of the information and resources at your disposal.  To help you with this process, we offer the following list of health insurance regulations and restrictions currently applicable in Texas.

• Every health insurance company in Texas is required to include a guaranteed-renewability clause in each health insurance policy sold here.  This means that, as long as you’ve made your premium payments, your health coverage here can be renewed each time it expires, at your discretion.  Your insurer is also forbidden to cancel your coverage on the grounds that your health has taken a down-turn.
• Any health issue that was diagnosed or treated within previous the five years can be designated a “pre-existing condition” by your new insurer whenever you switch to a new health plan.  These conditions are temporary excluded from your normal coverage, and it can take up to two years for this exclusion to end.  Exclusion periods that were imposed by your previous insurers will be credited toward your new policy, but by adding something called an “exclusion rider” your insurer can designate that a given condition is permanently exempt from being covered under that policy.  It’s important to be aware of this possibility when switching to a new health plan.
• Health insurance companies in Texas are permitted to accept or decline any application for health insurance, at their discretion, and may also use whatever criteria they wish when determining how much they will charge.  Typically, factors like age and health are among the most important criteria for these decisions.
• Small businesses in Texas that have no fewer than two employees— and no more than fifty— can expect to automatically have access to any group health insurance policy that is available to other small businesses in this state.  The pricing for such coverage is only barely controlled by state law, and will typically based on the risk factors of the insured employees.  This means that two companies with identical benefits can potentially end up paying vastly different amounts for this coverage.
• Insurers in Texas may impose certain requirements for a group policy granted to any small business.  These requirements can include maintaining at least a set minimum level of employee participation in the company plan, or perhaps a per-employee premium contribution by the employer.  Failing to meet the particular conditions set by the insurance provider can potentially mean termination of the entire policy.
• Self-employed Texans who have no other employees do not automatically gain access to group health insurance as a small business would, so they will typically need to purchase individual coverage instead.  Fortunately, the premiums paid by any self-employed policy-holder may be partially tax-deductible.

The lack of restriction imposed by Texas on its resident health insurance industry can make it seem much harder to buy the coverage you might prefer, but the silver lining is that this also makes the insurance market here more competitive.  If you are willing to keep yourself informed, and to compare offers from multiple different insurance companies, you can drastically improve your chances of finding good health insurance at an affordable rate.

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