- How Federal Health Care Reform will Affect You
- Your Health Care Coverage
- Health Care Coverage for Texas Children
- Health Maintenance Organizations
- Insurance for Texans with Disabilities
- Helping You with Your Insurance Complaint
If you're a parent or guardian, you'll want to ensure that your child has access to health care, including immunizations, preventive care, and routine and emergency health services.
Here are four options for finding health care coverage:
- Find group coverage
- Consider Children's Medicaid or CHIP
- Apply for coverage through the Texas Health Insurance Pool
- Buy an individual policy
Many employers offer group health coverage as part of their employee benefits packages. Most employers that offer a health plan also provide coverage to their employees' spouses and dependent children.
Your employers must give you at least 31 days from your start date to enroll in a health plan. After this time, you may be required to wait up to one year for the next open enrollment period to join. Insurance companies must offer a 31-day open enrollment period annually.
After you enroll in a health plan, your employer may have a 90-day waiting period before you are eligible to use your benefits. The company may not charge you or your employer a premium during this period.
If you're recently unemployed and you participated in your employer's health plan, you may have the right to continue coverage for yourself and your family under the federal law called COBRA and certain Texas statutes.
If employer-sponsored group coverage isn't an option, you may be able to find other group coverage. Trade unions, religious institutions, professional associations, and fraternal organizations sometimes offer health coverage as a membership benefit.
Read Your Health Care Coverage for more information about group plans and COBRA.
If coverage through your employer or an association or other group isn't available and you can't afford an individual policy, your children may qualify for Children's Medicaid or CHIP.
Medicaid is a federal/state program that provides health care coverage for children in need. Coverage is provided at no cost for children who qualify.
CHIP is a federal and state health coverage program for families who earn too much money to qualify for Medicaid but can't afford a private health plan. Private insurance companies and HMOs offer CHIP statewide. The fee is based on income and is $50 or less per family every 12 months.
Call 2-1-1 or visit www.211texas.org/211/ for information about qualifying for Medicaid.
Read Health Care Coverage for Texas Children for more information.
The health pool is a program for Texans who can't get insurance from licensed private insurers because of their health condition. Benefits cover hospital stays, physician services, and prescription drugs.
Coverage through the Health Pool may be expensive and premiums are twice the rate charged in the standard market.
The health pool will stop offering coverage on March 31, 2014.
Other options are to add your child as a dependent on your individual health plan, buy a child-only policy, or buy coverage through the insurance marketplace.
The federal health care law allows adult children who can't get health care coverage from their employers to stay on their parents' plans until age 26. It also prohibits health plans from denying or limiting coverage to children under age 19 with preexisting health conditions.
You can also find coverage through the online insurance marketplace (www.HealthCare.gov), which the federal government operates. The insurance marketplace will begin open enrollment periods for individual and small employer coverage in October and coverage will begin January 1, 2014.
Insurance companies won't be able to deny you coverage because of health factors, including a preexisting condition or disability. When deciding what to charge you after January 1, 2014, companies may only consider your age, where you live, whether you use tobacco, and whether the coverage you are buying is for an individual or a family. They also won't be able place annual dollar limits on essential benefits included in your coverage.
Companies will have to sell a plan to anyone who applies during the enrollment period. The enrollment period – for buying plans inside and outside the market -- runs from October 1, 2013 through March 31, 2014.
Note: If you don't purchase a plan during open enrollment, you may not be able to access coverage until the next annual enrollment period, which will run from November 15, 2014 to February 15, 2015.
People with incomes between 100 and 400 percent of the federal poverty level may be eligible for premium and cost sharing subsidies if they buy their insurance through the insurance marketplace.
View a list of carriers offering individual plans or search for an individual health plan on TDI's website. To verify an agent and company's licensing status, use the Agent Look-Up feature or view the company profiles on our website.
For more information about federal health care reform or to use the insurance marketplace, visit www.HealthCare.gov or call 1-800-318-2596 (24 hours a day, seven days a week).
For more information contact: