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Texas Health Insurance Benefits

Texas Health Insurance benefits plans vary from one plan to another. All health insurance plans are listed under the state-mandated plans or under the consumer choice plans. What’s the difference? Well a state-mandated health insurance plan provides the insured with certain required minimum benefits and coverages. To make Texas Health Insurance benefits coverage more affordable to all, Texas laws allow carriers to also offer consumer choice plans. These plans do not include all of the state-mandated benefits and are available at lower cost. If you decide to purchase a consumer choice plan, you will receive a list that discloses the benefits that are not covered in your policy. Another thing that should be understood when purchasing a Texas Health insurance consumer choice plan is that they coverages provided are not standardized through all providers. Every insurance provider has different benefits that it considers “standard” and asking questions will help you determine if it is the right plan for you.

Lets look at a few of the federally mandated benefits required to be provided in your Texas Health Insurance benefits. The first thing required by federal law is Maternity and Newborn coverage. Under the Texas Health Insurance Plan, any group health insurance plan in Texas must provide coverage for 48 hours of hospitalization after the child is born. In addition to the 48 hours of coverage, Texas Health Insurance plans also provide coverage for the newborn for up to thirty-one days after birth. If the mother wishes to continue coverage after the thirty-one days are up, she must contact her provider and pay any additional premiums required. Also required by federal law, any Texas Health Insurance plan can not deny or limit coverage because of a premature birth, illness, accident, or for any medical conditions present at birth. Included in this coverage, the Texas Health Insurance Provider must also cover any reconstructive surgery for the child up to his or her eighteenth birthday. Finally, any Texas Health Insurance provider cannot deny coverage listing pregnancy as a pre existing condition.

The only other coverage in the Texas Health Insurance benefits plan required by federal law has to do with Mastectomy benefits. With all Texas Health Insurance plans, no mater if you chose to go with a state mandated plan or a consumer choice plan, the health insurance provider must provide coverage to pay the cost of reconstructive surgery needed due to the original operation. The plan must also cover reconstructive surgery needed to provide a symmetrical appearance of the breast. As with all coverages in the Texas Health Insurance Plan, it may be subject to all applicable deductible, co-payments, and co-insurance charges. Included as part of the federally mandated coverage in the Texas Health Insurance plan is coverage that will cover prosthesis and for the treatment needed in the event of complications throughout the mastectomy.

In the next installment we will look at everything associated with HMOs in Texas Health Insurance plans including coverages, deductibles and co payments as well as what is and isn't covered Texas Health Insurance benefits