Texas Health Insurance

Texas Health Insurance provides uninsurable Texans with health benefits they so desperately need. Created in 1989 by the Texas legislature, the Texas Health Insurance Risk Pool is managed by a board of directors appointed by the Insurance Commissioner. Financing comes from insured premiums. When claims exceed paid premiums, the pool may charge the health insurance companies licensed to do business in the state.

Who Are Covered by the Texas Health Insurance Risk Pool?

Texas residents who are ineligible for other health insurance plans or who meet the federal definition of eligibility may apply for coverage. For example, someone who has a serious health condition such as cancer may simply show a letter from an insurance company declining coverage and they can sign up. Someone receiving an offer or having an existing policy where the premium exceeds what they would pay for the risk pool or excludes a medical condition can apply.

Who is Not Covered by Texas Health Insurance Risk Pool?

Anyone having health insurance coverage that is a similar premium or with greater benefits is not eligible. COBRA eligibility also makes access to the pool impossible until the term expires.

Benefits Available Under the Texas Health Insurance Risk Pool

There are four plans available each having a Preferred Provider Option. They differ only in the amount of the annual deductible the insured pays. The deductible amounts are $500, $1,000, $2,500, and $5,000. After the deductible is met, patients pay a 20% co-payment of the first $3,000 of medical expenses on preferred providers. An insured choosing a $500 deductible would pay a maximum total of $3,500 out of pocket in a one year period with the pool paying all other expenses. If a patient chooses a non-ppo provider, the co-payment is 40%, and there is no maximum out of pocket amount.