Texas Individual Health Insurance

Texas insurance regulations allow medical underwriting on all individual and family health insurance plans. Therefore, during the underwriting process health insurance companies may collect information about an applicant's medical history to determine eligibility for coverage.

Based on the medical history information obtained during underwriting, insurance companies may 

(1) issue standard medical insurance coverage according to the terms of the plan applied for,
(2) offer modified coverage, stating specific limitations, exclusionary periods or the attachment of an elimination rider, or
(3) decline to offer any coverage.

When an insurer is issuing any individual or family medical insurance plan in Texas (except HMO's) where the applicant did not have prior credible coverage, the state of Texas permits the insurers a 60-month look-back period and 24-month exclusionary period limit on pre-existing conditions. Elimination riders, which exclude coverage for specific medical conditions, are allowed for all individual or family health insurance plans in Texas. The state of Texas allows grandparents to include their grandchildren on their policy as dependents, if the grandchildren live with the grandparents and are under 25 years old.

For more information: Comparing Texas Health Insurance Companies

Small Group Health Insurance in Texas

All small group health insurance plans in Texas are offered on a guaranteed issue basis for groups of 2 - 50 employees. Therefore no employer groups or individual employee may be declined coverage because of their medical history. The insurance company is allowed a 6-month look-back, 12-month exclusionary period on pre-existing conditions for any group members that do not have prior credible coverage.

12 months is the maximum time allowed for the exclusionary periods when applying for Group Health Insurance in Texas. The insurance company may adjust rates by no more than 25% over the standard published rate based on the underwriting criteria. Affiliation or waiting period of 2 months may apply to new HMO medical policies, with the exception of late enrollees. Also mandated is that all small group health insurance plans in Texas are guaranteed renewable, so the insurance company must renew your policy upon your request and cannot refuse to renew because of excessive claims activity.

COBRA and Continuation Coverage in Texas

In Texas, the mini-COBRA law applies to groups with fewer than 20 employees. Texas state COBRA regulations requires that small groups allow qualified ex-employees to continue coverage under the group medical plan for up to 6 months after the termination date of employment. Any person accepting this COBRA option is responsible for the monthly payment of the health insurance premium, plus a 2% administration fee. To qualify, an employee must:

• have been covered under the group medical plan for at least 3 months and
• accept their COBRA coverage within 31 days of termination of coverage in the group medical plan.

COBRA is available for up to 18 months for groups of 20 or more. If an individual exhausts their 18 month federal COBRA option, they may apply for an additional 6 months of coverage under Texas state COBRA, providing them with a combined 24 months of COBRA continuation coverage.

Individuals who have exhausted their COBRA coverage and do not qualify for standard individual coverage should contact The Texas Health Insurance Risk Pool, which provides guaranteed issue coverage. If you have any questions regarding affordable health insurance in Texas, then please contact us.