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Your Rights under Texas Health Insurance Law
(Copyright 2005 All Rights Reserved)
Texas Individual Health Insurance:
In Texas, your access to individual health insurance may depend on your health status, but once you have health insurance, it cannot be canceled because you or anyone in your family becomes sick. Individual health insurance is guaranteed renewable, unless the insurance carrier cancels the plan.
Low or moderate household incomes may be eligible for free or subsidized health insurance coverage for all members of the family through a Texas sponsored Individual health insurance program. If your children are 18 years old or younger and are considered low income based on Texas guidelines, you may be able to purchase individual health insurance through the Texas sponsored health insurance plan or receive assistance paying for private health insurance. All states take part in the federally sponsored program that provides health insurance for children or expectant mothers and are considered low income.
If you enroll in the Texas Comprehensive Health Insurance Plan and are not HIPAA eligible, you will face a pre-existing condition removal period.
If you move away from Texas, you may not be able to buy individual health insurance in another Texas unless you are HIPAA eligible.
Under Texas law, newborns and adopted children are automatically covered under the health plan of the parents and are fully insured for the first 31 days, if the plan covers dependents.
If you have had difficulty obtaining affordable individual health insurance because of your health condition, you may also be eligible for a Texas sponsored Health Insurance Plan.
Eligibility for Medicaid in Texas is based on your household income. People with high medical expenses may also qualify for Medicaid.
To find out more visit the Texas Department of Insurance website is HTTP://WWW.STATE.TX.US
Texas Group Health Insurance:
Coverage under your group health plan cannot be denied or limited, nor can you be required to pay more, because of your health status. All group health plans in Texas must limit refusal due to pre-existing conditions.
If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your Texas group health insurance coverage for a limited time, of up to 12 weeks. Your employer must continue your health benefits. However, you will have to continue paying your share of the premium.
Texas group health insurance plans cannot apply a pre-existing condition refusal period for pregnancy, newborns, or newly adopted children, children placed for adoption, or genetic information. Increased premiums can be assessed on new groups if employees enrolling have any of the above. Existing groups may have their premiums increased to offset any extraordinary medical expenses the group may incur.
With few exceptions, small employers cannot be turned down for group health insurance in Texas. They can also require you to contribute a minimum percentage of your workers premiums.
If you are self-employed and buy your own self-employed health insurance in Texas, you are eligible to deduct 100% of the cost of your premium from your federal income tax.
If you lose your Texas group health insurance and meet other qualifications, you will be HIPAA eligible. You can buy an Texas individual health insurance policy.
If you have a legal dependent or disabled child, that dependent or child may remain covered under your fully insured Texas group health plan after he or she reaches the age at which dependent coverage is usually terminated for as long as the person remains dependent.
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