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Texas Individual Health Insurance  

We have gone over how to get Texas Health Insurance Coverage but what happens if you don’t pay your premiums or your Texas Health Insurance Company goes bankrupt? If the insured is covered by a Texas Health Insurance Company that goes bankrupt the state will cover their bill up to a certain amount, this is call a State Guaranty Association.  This does not cover any claims made by those insured with HMOs or Self-Funded plans, as well as any Fraternal Benefit plans. Should the insured be with an HMO plan, by state law the HMO plan must keep a set amount of cash and securities from which claims will be paid. If the HMO provider cannot pay then the Commissioner of Insurance can place those insured with the bankrupt HMO with another in another area.

What can cause your coverage to be dropped? With any Texas Individual Health Insurance Plan, the health insurance carrier cannot deny any currently insured Texan coverage because of health related factors.  However, a Texas Individual Health Insurance Provider can legally cancel your health insurance policy for other reasons including your failure to pay your monthly premiums, if the insured intentionally gave false information on their Texas Individual Health Insurance policy, and for filing any false claims or other forms of fraud committed against the Texas Individual Health Insurance Provider. If a Texas Individual Health Insurance Plan provider decided to discontinue writing and drop an Individual Health Insurance plan, the provider must cancel all policies under that particular individual health insurance plan. Should a Texas Individual Health Insurance provider do so, they must offer all of those affected by the cancellations the opportunity to purchase coverage under any other individual health insurance plan the provider has to offer.

Late payment on a Texas Individual Health Insurance policy can lead to the insured losing his or her coverage. There are carriers who offer Texas Individual Health Insurance plans that will accept late payments but they might have the insured reapply for their individual health insurance plan before the carrier will reinstate the health insurance plan.  If the insured is required to reapply, the individual health insurance carrier may again consider their health history before deciding to accept them again. Should the Texas Individual Health Insurance provider decide to reinstate their coverage, the reinstated coverage would only cover health cost incurred due to an accident only if the accident occurs after policy reinstatement. The reinstated pan will also only cover incurred expenses due to illness only if the illness began 10 or more days after policy reinstatement. When a carrier reinstates a Texas Individual Health Insurance policy, the carrier can also attach riders that would exclude certain coverage. The exclusions can be permanent or set for a specified period of time.

Under a Texas Individual Health Insurance policy, the death of a named insured or spouse will not inevitably terminate coverage; rather the surviving spouse would become the insured. If the insured loses coverage because of a change in marital status, the insured is permitted to begin their own Texas Individual Health Insurance policy.