Stateside Insurance Services is able to secure an offer for Texas health insurance coverage for over 80% of the individuals in Texas who apply. The remaining 20% of applications are declined by carriers due to health history that increases the carrier’s claims exposure in excess of the premium that can be charged for the coverage. Common reasons for an underwriting decision not to offer coverage include physical build outside the body mass index tables; serious medical conditions such as cancer, circulatory issues, diabetes, multiple prescription usage; or lifestyle issues such as alcohol or substance abuse.

For individuals who are declined, Texas health coverage is still available under a guaranteed issue basis from the Texas Health Insurance Pool (Pool). The Pool is charged with providing guaranteed issue health insurance coverage for those individuals who do not have access to health insurance coverage through traditional sources such as the employer sponsored group market or the individual market. The Pool was created by the Texas Legislature to comply with the 1996 Health Insurance Portability and Accountability Act. The term guaranteed issue means that if the applicant meets the eligibility requirements as established by the Pool, the individual’s application cannot be declined for coverage. In order to qualify for Pool coverage, an applicant must meet certain requirements.

The first of these requirements is that the applicant must be a Texas resident. Proof of residency can be in the form of a current Texas driver’s license, any other government-issued identification document or a utility bill. Whatever form is used to prove residency, the address on the document must match the address on the application.

An individual applying for Pool coverage must also demonstrate that the applicant does not have access to coverage through an employer-sponsored group plan or through a spouse’s employer group plan. If employer-sponsored group coverage is available, the individual will not be eligible for Pool coverage until the group coverage is no longer available.

Eligibility for Pool coverage also requires the applicant to confirm that coverage is not available based on one of several conditions. Eligibility can be documented by having an agent such as Stateside Insurance Services certify that health insurance in the individual market cannot be secured. The Agent Certification is part of the Pool application packet (Section I). The applicant can also present a letter of rejection from a state-licensed insurance carrier showing the declination of substantially similar individual coverage due to health reasons. Eligibility can be met even if insurance is offered by a Texas licensed carrier if the offer to insure includes a rider to exclude benefits for a specific medical condition. The individual can also qualify for Pool coverage by having a doctor’s office state that the individual has been diagnosed with or treated for one of the qualifying medical conditions. A list of the qualifying medical conditions can be reviewed at http://www.txhealthpool.com/eligibil.html#Qualifying%20Medical%20Conditions link.

An individual is ineligible if prior Pool coverage has been terminated for fraud, or for non-payment of premium during the past 12 months. An individual currently confined to a county jail or prison, is also ineligible.

Coverage through the Texas Health Insurance Pool is relatively easy to secure if the previous eligibility rules are met. If all of the correct documents are submitted to substantiate eligibility the application approval and enrollment is very straightforward. If you have any questions regarding Texas Health Insurance Pool eligibility, do not hesitate to contact Stateside Insurance Services at (866) 444-3332 (toll free).

Texas Jarvis is a licensed Texas health insurance agent with extensive experience regarding Individual Texas health insurance plans. Quote Texas health insurance

Tim Jarvis is a licensed Texas health insurance agent with vast knowledge of the Individual health insurance market in Texas. More Texas health insurance information can be found at http://www.texasplans.com

Author Bio: Texas Jarvis is a licensed Texas health insurance agent with extensive experience regarding Individual Texas health insurance plans. Quote Texas health insurance

Category: Finances
Keywords: texas life insurance, texas life quote, texas term life insurance, texas life insurance quote