The Texas Health Insurance Pool provides individual health insurance in Texas for those who can't buy private insurance because of health conditions. Any Texan who has been denied coverage because of his health has received a certificate from an agent stating that his health will make him unable to find coverage or has been offered coverage that is more expensive than it would be if purchased through the Pool is eligible. Dislocated workers and early retirees in certain trades who qualify for the Federal Health Coverage Tax Credit are also eligible to buy coverage through the Pool for themselves and their dependents.
Individual health insurance in Texas through the Pool covers physician care, hospital care, maternity care, mental health services and prescription drugs. There are five different plans available through the Pool, including one high-deductible HSA option which offers a lower premium and tax advantages. Premiums offered through the Pool cannot be sold for more than twice the cost of a plan a healthy person of the same age would pay a private insurer for the same coverage. Coverage is guaranteed renewable, meaning it cannot be canceled so long as premiums are paid and the policy holder continues to reside in Texas.
A person who has been diagnosed with a serious health condition such as AIDS, epilepsy or cancer is unlikely to be able to find individual health insurance in Texas at an affordable rate, and most policies are likely to include an elimination rider that excludes coverage for treatment of that illness. The Pool is designed to provide these Texans with coverage. In order to be eligible, a person must live in Texas, have no other current coverage and exhausted all other sources, including COBRA or other state continuation coverage. He cannot be eligible for another group health care plan, including Medicare or Medicaid.
There are no exclusions for pre-existing conditions for those eligible for HCTC or under the Health Insurance Portability and Accountability Act (HIPAA) and cannot include riders to exclude coverage for any reason. However, those not covered by HCTC or HIPAA could be subject to a 12-month waiting period for pre-existing conditions. As of January 2010, over 26,000 people had individual health insurance in Texas through enrollment in the Pool, which operates as a PPO through the BlueChoice簧 Network through BlueCross and BlueShield of Texas. Services by in-network providers are covered at a higher co-insurance rate meaning lower out-of-pocket costs to the Pool member.
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