High Risk Health Insurance in Texas-INSTANT ONLINE RATES


BLUE CROSS BLUE SHIELD (BCBS) exchanges rates here…..

Now available to Texans that have A Pre-Existing Condition and have been declined. THIS IS NOT A DISCOUNT PLAN but the Government Guarantee Issue Health Insurance.


High Risk Health Insurance in Texas
High Risk Health Insurance in Texas
High Risk Health Insurance in Texas
High Risk Health Insurance in Texas

Now available to Texans that have A Pre-Existing Condition and have been declined. THIS IS NOT A DISCOUNT PLAN but the Government Guarantee Issue Health Insurance.



Premium rates for Texas

Here are the 2011 monthly PCIP premium rates for Texas by the age of an enrollee, effective July 1, 2011.

Age Standard Option Extended Option HSA Option
0 to 18 $133 $179 $138
19 to 34 $199 $268 $207
35 to 44 $239 $323 $248
45 to 54 $306 $412 $318
55+ $426 $572 $442




Because of national health reform, Texas presently has two separate high-risk pools that provide medical health insurance to Texans who cannot get coverage within the private market because of pre-existing health problems: the condition-given Texas Medical Health Insurance Pool, established in 1998, and also the government given Pre-existing Condition Insurance Policy produced through the new federal health reform law. Because condition law in Texas enables health insurance companies to deny coverage to individuals with pre-existing conditions within the individual market (coverage bought from an insurance provider, instead of job-based coverage), many Texans with health conditions are only able to get coverage via a high-risk pool. By The month of january 2014, the brand new federal health reform law will stop insurance providers from denying coverage or growing rates with different person’s health status or pre-existing conditions. For now, high-risk pools continues use a lifeline to hundreds of 1000’s of Texas citizens who require medical health insurance. This Insurance Policy Page describes each of Texas’ high-risk pools-their commonalities, variations, and important approaching changes.

Evaluations of Key High-Risk Pool Features

With two high-risk pools to select from-the Texas Medical Health Insurance Pool (THIP) and also the new Pre-existing Condition Insurance Policy (PCIP)-Texans with pre-existing conditions will have to compare both options and find out which best meets their demands. Though they serve an identical purpose, they’ve different rates, benefits, and qualifications criteria.


Rates vary between your two pools. Cost is a restricting element in THIP, the present condition risk pool, which by condition law must charge two times around the typical rates billed to healthy people within the private, individual marketplace for similar coverage. PCIP, the brand new federal risk pool, charges average individual market rates, so generally, PCIP’s coverage is less costly than THIP’s.1

Benefits THIP will begin a brand new low-earnings, sliding-scale premium subsidy enter in The month of january 2011 with maximum discount rates as high as 50 %.

PCIP and THIP both cover primary and niche care, hospital care, and prescription medications. PCIP provides a single plan option having a $2,500 deductible and limits an enrollee’s annual out-of-pocket cost-discussing to $5,950 in-network. THIP’s coverage is made to be much like commercial individual market coverage options, with insurance deductibles varying from $1,000 to $7,500 annually. Based on deductible, annual out-of-pocket limits for THIP plans vary from $4,000 to $12,500, plus copayments. A vital benefit difference is PCIP doesn’t have pre-existing condition waiting period, and THIP includes a 12-month pre-existing condition waiting period for enrollees who don’t have a minimum of 12 several weeks of prior coverage. Generally, PCIP has better preventive benefits, within-network maintenance for example annual physicals, mammograms, and cancer tests fully included in PCIP and never susceptible to enrollee insurance deductibles or copays. Generally, THIP has more generous pharmacy benefits, with prescription medications susceptible to another, reduced deductible than medical benefits.


With varying qualifications criteria, some Texans will discover they’re qualified for just among the two high-risk pool options. For instance, PCIP is just available to those who have been without insurance not less than six several weeks. This prevents current THIP enrollees yet others with current coverage of health from switching to PCIP unless of course they drop coverage and go without insurance for six several weeks. THIP doesn’t need candidates to become without insurance before enrolling, and therefore will stay and important supply of coverage for Texans with pre-existing conditions who wish to maintain continuous coverage. THIP continues for everyone current enrollees along with other Texans, for instance people retiring before Medicare insurance qualifications, tiring COBRA coverage, or beginning their very own business, who cannot risk a six-month stretch without being insured coverage.

If an individual is qualified for programs and may choose from the 2, on balance, PCIP will normally be considered a better cope with lower rates with no pre-existing condition waiting period. The next sections provide more particulars on pools’ qualifications, rates, benefit, and funding.

* THIP rates effective August 1, 2010 for $2,500 deductible plan. THIP rates vary by deductible plan level, age, gender, geography, and smoking status. Full premium tables offered at world wide web.txhealthpool.org/rates.html.

** PCIP rates effective August 1, 2010 for PCIP’s plan, with a $2,500 deductible. PCIP rates vary only by age. Premium tables offered at world wide web.pciplan.com/candidates/states/Texas.html.

Two High-Risk

Texas Medical Health Insurance Pool


The Texas Medical Health Insurance Pool (THIP) was produced through the Texas Legislature to supply medical health insurance to qualified Texas citizens who’re not able to acquire coverage from private insurance companies because there is a pre-existing health problem. The pool started offering coverage in 1998, and by June 2010 had 26,894 Texans enrolled. Complete details about THIP can be obtained online at world wide web.txhealthpool.org.


To be eligible for a THIP, people must generally be under age 65, be considered a Texas resident, be considered a U.S. citizen or legal permanent resident, don’t have any use of employer-backed coverage, and meet any of the following criteria below:

• Be not able to obtain individual medical health insurance because of health reasons. Candidates can be this having a notice of rejection by an insurance provider, a certification by an insurance coverage agent the applicant could be rejected, or perhaps a diagnosis with certain health conditions-for example cancer, cardiovascular disease, or diabetes-that will lead to an insurance provider rejection.

• Have the ability to only have an individual health insurance plan that excludes coverage for existing conditions or

• Have experienced 18 or even more several weeks of previous employer-based coverage of health without any gaps in coverage more than 63 days. Such enrollees are given special insurance portability protections under federal HIPAA law.2

Most people who’re qualified for job-based coverage (through their job, a spouse’s job, or perhaps a parent’s job), are ineligible for THIP-even when they aren’t signed up for their job-based coverage-using the following two exceptions:

• People shifting from employer-backed coverage who haven’t exhausted their 18-month COBRA continuation coverage may access THIP coverage having a minimum six-month pre-existing condition exclusion period if otherwise qualified for that pool.3

• People with job-based coverage who meet each one of the following three conditions may elect THIP coverage: (1) they’re employed part-time, (2) their employer will not make any contribution toward their employer-backed coverage, and (3) the business-backed coverage is much more limited compared to pool coverage. Other people with use of job-based coverage with limited benefits remain ineligible for that pool.


THIP coverage is costly. By condition law, rates are positioned at two times the typical private, individual market rates billed to healthy people for the similar coverage.4 Rates within the Texas individual medical health insurance market are completely not regulated. The typical monthly premium within the pool is $712 monthly.5

Approaching Low-earnings Premium Subsidy Program According to rating factors such as age, gender, geographic area, deductible selected, and smoking status, THIP rates vary from $160 to $2,207 per month. Because the pool started offering coverage in 1998, rates have elevated 10.5 % each year normally.

The cost of THIP rates places its coverage from achieve for a lot of Texans, especially individuals with low and moderate earnings. Last Year, the Texas Legislature passed HB 2064 by Representative Smithee, which determines a sliding-scale premium discount program for lower-earnings THIP enrollees. Premium subsidies will start to address THIP cost issues and help it to satisfy the requirements that it had been produced-growing use of coverage for those who are medically uninsurable.


Premium subsidies will start on The month of january 1, 2011. Enrollees with household earnings below 200 percent from the federal poverty level (FPL, presently about $36,600 for any group of three) will get 50 % from rates. Enrollees with household earnings between 200 and 300 percent FPL ($36,600-$54,900 for any group of three) will get 30 % from rates.

Subsidies is going to be funded with a area of the “prompt pay” penalties that insurance companies and HMOs pay to network hospitals and doctors once they pay claims late. According to prompt pay penalties compensated in the past years, Texas insurance companies estimate the area of the penalties rerouted to THIP may total $ten million annually. Consider the particular funding collected will rely on late claims obligations, the total amount collected from year-to-year can’t be known ahead of time. Throughout 2010, THIP continues to be collecting prompt pay penalties that’ll be accustomed to fund 2011 subsidies.

The quantity of funding ultimately readily available for subsidies is going to be limited and rarely is in enough to pay for all current THIP enrollees who’re qualified. THIP estimations that about 3,000 enrollees could receive premium assistance this year, should THIP collect $ten million this year prompt pay penalties. According to member surveys, THIP anticipates it has more enrollees in who’re earnings-qualified for subsidies than likely funding covers. If the works out to be, THIP anticipates needing to begin a waiting list.

Programs for premium subsidies were mailed to any or all current THIP enrollees at the outset of This summer 2010. Programs aren’t readily available for people not presently enrolled, because at this time, THIP doesn’t anticipate sufficient funding to increase subsidies to new enrollees.

THIP enrollees thinking about the premium subsidy program should return their application as quickly as possible. THIP accepts members’ prior year’s tax statements as evidence of earnings. THIP enrollees who’re not needed to file for taxes or whose household earnings has transformed substantially since filing 2009 taxes may prove earnings utilizing an alternate method.

Pre-existing Condition Waiting Period

Care associated with pre-existing conditions is excluded from THIP coverage for that first 12 several weeks. This waiting period doesn’t affect THIP people who’re HIPAA-qualified. For enrollees who’re not HIPAA-qualified, THIP “credits” any prior coverage to lessen the pre-existing condition waiting period. For instance, a swimming pool applicant with three several weeks of prior insurance policy is going to be susceptible to a nine-month exclusion period. THIP people who’re still inside their 18-month COBRA continuation period once they enroll are subject low six-month pre-existing condition exclusion period.6


The pool’s nine-member Board of Company directors determines the pool’s covered services, exclusions, annual insurance deductibles, coinsurance needs, and co-payment amounts. Condition law directs the board to create pool coverage to become in line with guidelines available available individual medical health insurance market.7

Covered services include hospitalization, emergency care, surgery, physician visits to the doctor, home healthcare, hospice care, serious mental illness services, physical rehabilitation, and prescription medications. The pool relies on a Blue Mix and Blue Shield of Texas state-wide preferred provider network. Enrollees pay 20 % coinsurance for services shipped by preferred companies and 40 % coinsurance for out-of-network companies. THIP offers five different deductible levels: $1,000, $2,500, $3,000 (health checking account qualified), $5,000, and $7,500. Last Year, 75 % of THIP people were signed up for the $2,500 or $5,000 deductible plans, with enrollment split nearly evenly between your two.


All THIP plans possess a $two million lifetime maximum. The brand new health reform law forbids dollar-value lifetime limits in insurance policy years beginning after September 23, 2010, but this provision doesn’t affect high-risk pool coverage (to Out-of-pocket maximums in THIP vary from $4,000-$12,500 each year based on which deductible-level plan’s selected.


THIP or PCIP). However, because condition law directs THIP to consider coverage in line with private market coverage, THIP will probably adopt coverage without any lifetime limit because it becomes prevalent within the private market.


Because condition risk pools generally serve less healthy people, the typical claims cost per enrollee is usually extremely high. No state’s risk pool relies exclusively on enrollee rates to pay for claims costs. THIP is funded mainly by rates compensated by enrollees and checks on insurance companies and HMOs. The pool doesn’t get any condition General Revenue funding. Last Year, THIP collected $199 million in member rates, $77 million in insurance provider checks, and $11 million in federal grants or loans. Last Year, THIP compensated out $273 million in medical and pharmacy claims and $13 million in administrative expenses.9 Within the 12-year good reputation for the pool, enrollee rates have paid for for 66 percent of pool revenue and insurance provider checks have paid for for 33 percent of revenue.10

Pre-existing Condition Insurance Policy


The Pre-existing Condition Insurance Policy (PCIP) was produced through the new federal health reform law. U.S. Department of Health insurance and Human Services (HHS) offered each condition the chance to manage its very own risk pool under health reform. Governor Perry, together with 20 other governors, elected rather to allow the us government administer the brand new high-risk pool for his or her states. PCIP is really a temporary plan which will operate until 2014, when health reform will stop health insurance companies from denying coverage or charging greater rates according to pre-existing conditions.

HHS has contracted using the Government Employees Health Association (GEHA) to manage PCIP benefits within the 21 states that elected for any government given plan. PCIP enrollment began on This summer 1, 2010 for coverage beginning on August 1. PCIP information and applications in British and The spanish language can be found at world wide web.pciplan.com.


To join PCIP, candidates must satisfy the following three criteria:

• Be considered a citizen or national from the U . s . States or legitimately contained in the U . s . States

• Happen to be without insurance not less than the final six several weeks and

• Have experienced trouble getting insurance because of a pre-existing medical problem.

To show they have had trouble getting insurance because of a pre-existing medical problem, candidates must submit instructions from an insurance provider in the last six several weeks rejecting them for coverage because of pre-existing conditions, or offering only limited coverage that excludes benefits for pre-existing conditions. Unlike THIP, PCIP doesn’t presently have a listing of medical diagnoses that qualify an individual for coverage without needing to have an insurance provider rejection letter.

The reform law forbids insurance providers from rejecting children under age 19 from coverage because of pre-existing conditions after September 23, 2010. After they can no more be refused coverage, children can sign up for PCIP only when the premium they come within the private marketplace is a minimum of two times around PCIP rates.


The reform law mandates that PCIP rates remain consistent with average rates billed within the private sell to healthy people, unlike THIP, which sets rates at two times this level. Rates for PCIP aren’t always 1 / 2 of THIP’s because benefits and rating structures vary between your programs, however in general, PCIP rates are less costly than THIP’s.


PCIP rates vary only by age and vary from $323 to $688 per month. PCIP doesn’t offer subsidies for enrollees with low earnings.

Pre-existing Condition Waiting Period

PCIP doesn’t have a pre-existing condition waiting period.


PCIP covers primary and niche care, hospital care, and prescription medications. PCIP provides a single plan level having a $2,500 annual in-network deductible. In-network preventive services for example annual physicals, mammograms, cancer tests, and immunizations can be found without any cost-discussing. Doctors visits are susceptible to a $25 co-payment along with other services are susceptible to 20% coinsurance if shipped by preferred companies and 40% for out-of-network companies. PCIP comes with an annual out-of-pocket more $5,950 in-network and $7,000 out-of-network. PCIP doesn’t have an eternity maximum.


As with every high-risk pools, rates alone is going to be inadequate to pay for medical claims. Additionally to rates, PCIP is funded by $5 billion appropriated through federal health reform. Texas continues to be allotted $493 million to pay for pool expenses more than rates through 2013. PCIP will dissolve in 2014, when health reform prevents insurance companies from deny coverage or charging more because of pre-existing conditions.

Several questions happen to be elevated concerning the adequacy of PCIP funding. If the funding will cover the 41-month period between now and 2014 will be based mainly on the number of people enroll, how quickly they enroll, and what health care they receive-all products that can’t be predicted with much precision. The reform law grants or loans HHS authority to create changes towards the program if required to help keep it within budget, including restricting enrollment, raising rates, or reducing benefits. Should funding prove inadequate, it’s possible that HHS can make changes towards the program to help keep it in budget. It’s also entirely possible that Congress would appropriate additional funding.


Texas’ current high-risk pool provides vital coverage to almost 27,000 Texans. With the development of PCIP, many Texans with pre-existing conditions who’d well be without insurance will obtain access to coverage. These programs provide concrete help now to Texans who’ve trouble getting coverage within the private market due to a pre-existing condition. These programs function as a bridge to 2014, when, due to health reform, coverage of health will ultimately be accessible to any or all Texans no matter their own health status.


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