Texas High Risk Health
Insurance Pools
 What do AIDS, Epilepsy and the possession of an artificial heart valve all have in common? They're three of the many conditions that classify you as "high risk" from an insurance standpoint, which means that even the open enrollment in your company's benefits program can result in a notification that you are uninsurable.
The good news is this: If you live in Texas, you live in a POOL state, and when we say "pool" we're not talking about swimming or billiards. We're referring to pool insurance. It's a state-mandated insurance program that allows people with those high risk conditions to still have medical insurance both for themselves, and their dependents, as long as they can afford the premiums.
That last clause, "as long as they can afford the premiums" is a crucial one, because pool insurance, or a "risk pool" does not exist to serve the poor, though some states do have special pool insurance to supplement Medicaid.
|
|
Here are other facts about pool insurance:
- Pool insurance premiums are generally higher than regular individual insurance, but they are capped by law so that they don't become exorbitant. Caps range from 125 - 200 percent of whatever the average private insurance fee is for the state, but is usually under 150 percent.
- Risk pools are money losers, and must be subsidized. While part of the cost comes from insured-paid premiums, about half of the overall operating costs are not covered by those fees. Provider surcharges, tobacco taxes, and even assessments on insurance carriers are some of the sources of subsidization.
- Because pool insurance is designed for people who would not otherwise be able to buy health insurance, there are usually no exclusions, which is a fancy way of saying "you can't be turned down."
- Even though there may not be exclusions, pre-existing conditions may still have a "waiting period" of up to six months before they will be covered, unless they meet COBRA requirements.
- Eligibility requirements for pool insurance vary from state to state. In Texas, the general requirements are that you must be under the age of 65, and a legal resident of the state for at least 30 days, or the country for three continuous years, and you also have to provide proof that you were rejected by an insurance company offering similar benefits.
|
