Individual Health Insurance Texas
What is a deductible?
It is a specific dollar amount that an individual must pay themselves before an insurance company starts to pay. The higher the deductible, the lower the cost of the business, family, or individual health insurance; Texas Health Insurance Solutions has many plans available for you.
What is coinsurance?
Once you have met your deductible your coinsurance kicks in. Your co-insurance is the amount that an insured person and the health insurance company will pay. The most common coinsurance is an 80/20 plan. Once you have met your deductible the insurance company pays any remaining charges at 80% and you pay 20%.
What is the maximum out-of-pocket expense?
This is the most important question that you should ask yourself when purchasing a health insurance policy. A maximum out-of-pocket expense is the amount of money that you would be responsible for on your plan in a calendar year. Another way to look at it would be to ask yourself if you or your family had a lot of medical expenses in one single year, what would be the most you would be responsible for paying out of your pocket. This is your deductible and co-insurance.
What is a State mandated benefit?
A mandate benefit is a specific coverage that an insurer is required to include in its contract under state law. For example, the State of Texas requires that coverage for Childhood Immunizations be provided. Other kinds of coverage that are mandated in Texas would be mammograms & PSA testing.
What is a PPO?
A preferred provider organization (PPO) is an association that contracts with a group of doctors, dentists, hospitals or other health care service providers to provide care at renegotiated rates or discounts.
What is the major difference between group and individual insurance?
The major difference between the group and individual health insurance that Texas Health Insurance Solutions provides involves evidence of insurability. To purchase individual insurance, a person must generally answer a health questionnaire to provide evidence of insurability to the insurance company. An insurer may decline coverage on the basis of the applicant's personal habits, health, medical history, age, or any other factors that bear on risk acceptance. Or the insurer may issue a policy with limitations on coverage. Most group insurance, however, is issued without medical examination or other evidence of individual insurability because the insurer knows that it can cover enough individuals to balance those in poor health against those in good health.
What is a mini med?
Mini-meds (also called "defined benefit" health plans) are guaranteed-issue health insurance, which means anyone can buy them regardless of pre-existing health conditions. There is limited to no health questions asked and underwriting is mostly guaranteed.
These plans have defined limits on coverage, which means less risk for the insurance company. They pay set amounts and are not designed to provide catastrophic coverage.
What is the average health insurance, Texas premium?
The average health insurance premium depends on a variety of factors:
Insurance type
Age
Benefits
Health Status
Geographic Location
What Are Health Savings Accounts?
In 2003, the federal government designed a new type of insurance primarily for the self employed called a health savings account (HSA), to make it easier for some people to afford health insurance. Those who are eligible can reduce health insurance premiums and save tax dollars, too.
What is a health savings account (HSA)?
A health savings account is a tax-advantaged personal savings account that works in conjunction with an HSA compatible health plan. You can use your HSA to pay for current and future qualified medical expenses tax-free.
How much can I contribute to an HSA?
Yearly maximum contribution levels are set by the federal government and they usually increase each year. For 2009, you can contribute up to $3,000 if you have a individual HSA compatible health plan coverage, or $5,950 if you have family HSA compatible health plan coverage. In 2010, the maximums will increase to $3,050 (single) and $6,150 (family) for family coverage. If you are age 55 or older, you can make an additional catch-up contribution amount of up to $1000 per year.
Can I use funds from an HSA for non-qualified medical expenses?
Yes, but you'll be required to pay income tax and a 10 percent tax penalty on the amount you use for non-qualified medical expenses
What is a provider?
A provider is a hospital, health care facility, physician or other medical professional that provides health care services.
What is the difference between an in-network and an out-of-network medical provider?
An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not on the list. If you go to a doctor in network you save yourself and the insurance company money. If you had an 80/20 coinsurance plan and you went to a provider out of network they usually penalize you by dropping your coinsurance to a 60/40 for that visit alone.
Under a new health insurance plan, can I keep my doctor?
You should review a health insurance plan's physician network before applying to the plan.
What is an office visit copayment?
An office visit copayment is a fixed dollar amount that you pay for each doctor visit.
Which type of health insurance is right for you?
Whether you are eligible for group insurance or choosing an individual plan, you should carefully compare costs and coverage. Be sure to compare:
1.Premiums. 2. Coverage/benefits. 3. Access to doctors, hospitals, and other providers. 4. Access to after hours and emergency care. 5. Out-of-pocket costs (coinsurance, co-pays, and deductibles). 6. Exclusions and limitations.
Can health insurance companies deny my application for individual insurance due to a health condition?
Yes, a company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage, the company cannot cancel your policy except for nonpayment of premium.
What is a pre-existing condition?
This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy.
What if I am pregnant or adopting, can I get coverage?
Unfortunately until the child is born and has had their first well baby checkup insurers will not accept an applicant for coverage.
Is maternity covered in Texas?
In Texas maternity is not covered on major medical plans for an individual or family. If you are on a group plan maternity is covered.
I have previous group health insurance coverage. Does this mean the health insurance company must accept my application and apply no pre-existing condition limitations?
No. In Texas it does not matter that you have previous group health insurance coverage. A health insurance company can still deny your application for individual or family coverage. However, if your application is declined, you may be eligible to participate in the Texas Health Risk Pool (www.txhealthpool.org ) established for persons who are unable to obtain health insurance coverage on the open market.
Can my health insurance be terminated for any reason?
Texas provides strong consumer protection. In general, the insurance company can terminate your coverage for only the following reasons:
(1) If you fail to make premium payment within the payment grace period
(2) If you omit or misrepresent a health issue on your health insurance application
(3) The insurance company entirely withdraws from the individual health insurance, Texas business.
Is there a difference in the underwriting process from one company to another?
Yes. Most definitely! While one company may not take someone with a certain pre-existing condition others will. Height and weight is probably the biggest difference between companies. Some are more liberal on their underwriting than others. For example, one insurance company assigns "preferred" rates to a 5'10" male who weighs 215 lbs. Another insurance company would assess an additional 40% charge for this person. One insurance company charges an additional 40% for smokers. Another charges an additional 25%. One might not charge a rate increase at all. To get the best value on group or individual health insurance, Texas Health Insurance Solutions has specials that can help.
