Texas insurance law and regulation
News that affects your health insurance and planning
June 3, 2019 – Status of alternative non-ACA health plans: Texas does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 29, 2019 – Small business health plans – Yesterday a federal court in the District of Columbia ruled in favor of states in striking down U.S. Treasury regulations that permitted the expansion of small business association health plans. Even before the court ruling, association health plans were not showing promise as cost-saving measures as was hoped. What this means to small businesses is that if they want a lower cost health plan then they must design it themselves independently from an insurance company. The problem is that most firms providing benefits services are primarily in the business of selling insurance rather than lowering costs. Freedom Benefits offers an affordable consultation to help small business owners design and document an alternate small business health plan without necessarily requiring the purchase of insurance.
December 1, 2018 – Texas had a sharp increase in the number of uninsured children, Georgetown University’s Center for Children and Families reports that one fifth of all uninsured children in the US live in Texas. Freedom Benefits reported the trend nationally in this blog post.
November 24, 2018 – FREE HEALTH INSURANCE COUNSELING – Michael Health System is offering free counseling to people seeking individual or family coverage through the Health Insurance Exchange during open enrollment through Dec. 15. Certified application counselors will be available at 3101 Kennedy Lane, Suite 1200, Texarkana, Texas, to help guide participants through the enrollment process, clarify if their health care provider will continue to be in network and determine if they qualify for insurance premium assistance. Participants can call 903-614-2776 to make an appointment. Walk-ins are also welcome. OnlineNavigator offers online assistance through this web site. Smart Insurance Exchange offers live telephone support for its range of supplemental and alternate coverage options.
The history of health care planning in Texas (Information is outdated and links may be expired)
6/8/2016 Blue Cross and Blue Shield of Texas’ proposal to raise 2017 health insurance rates by as much as 57% to 59% has sparked concern by individuals and small businesses that purchased Obamacare coverage. New York Times reports that similar health insurance cost hikes are proposed in many other states.
9/3/2015 Blue Cross and Blue Shield of Texas will discontinue its preferred-provider-organization health insurance plans to individual consumers in 2016.
11/17/2014 Individual health insurance rates rose an average of 7.6% over 2014 levels. The actual rate change depends on where you live. A small part of the state received a rate decrease in 2015 while the rare increases varied from 2.8% to 16%.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683 ext. 1
7/26/2013 Affordable Smart Term Life Insurance is now available to most Texas residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/11/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
7/16/2-12 Four physicians in the Texas legislature announced support for Governor Perry’s stance on resisting Medicaid expansion. The state also announced that the Healthy Texas will soon close. Alternatives to Healthy Texas will be available to current enrollees.
7/9/2012 Texas notified the federal government today that the state will not participate in key measures of health insurance reform. Texas will not set up an insurance exchange nor expand Medicaid coverage to the 6.2 million Texans who are uninsured. The Supreme Court ruled last month that states could refuse to expand Medicaid coverage and the Affordable Care Act makes state involvement in an insurance exchange voluntary. The federal government may take steps to operate an exchange for Texas residents however few have participated in the federal insurance exchange at HealthCare.gov, according to Tony Novak at OnlineNavigator.org. Similarly, few Texas businesses have participated in state insurance programs like Healthy Texas.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross Blue Shield of Texas and UnitedHealthcare are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
11/7/2011 Texas opened its Children’s Health Insurance Program (CHIP) to the kids of low-income and part-time state employees, an option that was prohibited until the passage of the 2010 health-care law. The program is jointly financed by the state and the federal government to provide coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.
8/19/2011 Texas Leadership Center received $1 million grant from the federal government to promote health insurance among at-risk adolescents and their families in 17 high schools in five school districts in Hildago and Harris counties. Community Council of Greater Dallas received a grant of $898,954 to partner with the WIC offices managed by the City of Dallas and Outreach Health Services to form the North Texas CHIP and WIC Project that will assist eligible north Texas families, especially Latinos, in applying for and retaining Medicaid and CHIP coverage for their children. Texas Association of Community Health Centers, Inc. received a grant of $978,714 to lead a coalition, including Federally Qualified Health Centers and various partners, in conducting community-based outreach and enrollment activities targeting low-income Hispanic children, including the children of migrant and seasonal farm-workers.
8/16/2011 The New York Times highlighted Texas’ problem with lack of health insurance for about 1/4 of its population, the highest level of uninsured residents among all states in the U.S. This issue is likely to receive increased media attention following Governor Perry’s announcement of candidacy for President. Consumers may indirectly benefit from the state’s increased focus on promoting affordable insurance options.
7/22/2011 The UnitedHealthcare and the Houston Citizens Chamber of Commerce will host a reception to introduce small-business owners to Healthy Texas, a statewide health initiative to offer affordable health insurance to small-business employees and their families. “Keeping your employees healthy and managing health care costs are significant factors of operating a successful business,” said Eric Lyons, president and CEO, the Houston Citizens Chamber of Commerce. “Healthy Texas is a great opportunity for small businesses who previously couldn’t afford to offer their employees health insurance plans. We hope our community takes advantage of this new insurance program.” Freedom Benefits provides qualification and enrollment support for Healthy Texas. See the articles section for more information.
3/7/2011 The Texas health insurance exchange bill was amended to omit provisions of an individual healthy insurance mandate, despite uncertainty of its outcome at the federal level. It is unclear whether this is a measure of political gamesmanship or a statement of intent, but is likely to be popular among Texas voters.
2/21/2011 At the request of Celtic Insurance Company, Tony Novak is not selling Celtic Healthy Texas and OnlineAdviser enrollment support is no longer available for Celtic Insurance products in Texas. A spokesperson for the company said “I don’t see that we can accommodate your style of eCommerce with this product”. The company also referred to specific complaints from the Texas Department of Insurance but we were unable to verify details. More coverage on this topic is available on the Universal Health Insurance blog. OnlineAdviser help requests for Healthy Texas will be referred to UnitedHealthcare Healthy Texas. Separately, a new help chart in PDF format is available to help Texas small businesses determine their eligibility for Healthy Texas and the number of employees required to participate. Requests for Celtic Insurance in Texas will be referred to a licensed local producer.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
2/8/2011 The Senate State Affairs Committee released a report this week saying that the Healthy Texas program had only attracted 17 groups with 31 total enrollees statewide. Healthy Texas is a small business insurance program offered jointly by the sate and two private health insurance companies – Celtic Insurance and UnitedHealthcare. We previously published a review of the program including the pros and cons of Healthy Texas.. Apparently the cons are dominating most small business owner’s decisions. Of the five small businesses we spoke with who obtained a quote for the Celtic Healthy Texas plan, all opted for traditional group or individual health insurance coverage. UnitedHealthcare entered at a later date and we have no experience with the plan. See the resource links on any of the pages above for more information.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
2/3/2011 A report titled “2011-2016 Texas State Health Plan; A Roadmap to a Healthy Texas” by the Statewide Health Coordinating Council details plans for including the challenges incurred in caring for residents without insurance or for providing health services not fully covered by insurance. The tone of the report indicates that the state recognizes the need to address these critical issues apart from the insurance challenges. Separately, Celticenrollment.com published an article titled “Clarification of “Healthy Texas” program name” to address confusion over insurance and non-insurance entities sharing use of the name.
1/13/2011 Texas Health and Human Services Commission announced that a number of popular state insurance programs including Medicaid, Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, Children’s Health Insurance and other programs will be run by Maximus (NYSE: MMS), a for-profit company, for a total contract price of $315,300,000. The contract contains an optional two year extension provision. The stock price of Maximus rose .2% on the day of the announcement
12/16/2010 Texas Department of Insurance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Texas said that it would: 1) Coordinate Texas’ Exchange planning efforts between the Texas Department of Insurance (TDI) and the Texas Health and Human Services Commission (HHSC), 2) Use funds to examine specific circumstances of the State, and 3) Develop considerations about setting up regional Exchanges within the State.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
Texas currently has the highest percentage of uninsured (over 26 percent) of any state in the country, as well as the second highest number of uninsured residents (over 6 million).
12/7/2010 Effective immediately, “discretionary clauses” that give insurance companies sole discretion in interpreting coverage provisions are no longer allowed in Texas insurance policies. Experts agree that this will raise insurance rates but offer better protections to consumers. A growing number of states are considering laws to ban discretionary clauses from life and health insurance. The subject is further explained on the Universal Health Insurance Blog.
11/22/2010 Consumer-directed articles and downloadable brochures about Healthy Texas and alternatives are now available. At tis time rates and enrollment support are only available for the three Celtic Healthy Texas plans.
11/8/2010 Alternatives to Medicaid and CHIP Needed – Following the results of last week’s election, the Texas legislature is expected to trim some of the 3.6 million from coverage under the state’s health insurance programs for low income residents. The move will reportedly save the state $60 billion over five years from 2013-2019. Lawmakers are concerned about the decrease in the number of businesses and individuals to elect to enroll in health plans since the announcement of expanded federal programs earlier this year and believe that immediate legislative action may be required to change this consumer behavior. We believe that once businesses and individuals realize that free government health care is not on the way, they will return to the normal patterns of budgeting for at least basic health insurance. Freedom Benefits will respond by promoting the new low cost limited benefit plans available to individuals and businesses. Small businesses that add these plans receive a tax credit for up to 35% of the cost of coverage. While comprehensive coverage is still priced out of reach of many Texans, limited benefit health plans are now more affordable and more widely available than in prior years.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Texas is now available at Freedom Benefits.
3/23/2010 Texas and ten other states including Alabama, Florida, Michigan, Nebraska, North Dakota, Pennsylvania, South Carolina, South Dakota, Utah and Washington will make a joint legal challenge to the federal health reform bill on the basis that it improperly usurps state sovereignty over health insurance and that requiring health insurance is an illegal and improper government action.