Austin Health Insurance Information

• Can I buy health insurance for less if I deal directly with an insurance company?
• Must I pay a fee to an independent health insurance agent?
• I have previous group health insurance coverage.  Does this mean the health insurance company must accept my application and apply no pre-existing condition limitations?
• What are my options if I my application for coverage is denied?
• Can my health insurance be terminated for any reason?
• What is short-term health insurance?
• What are "pooled" health insurance rates?
• Under a new health insurance plan, can I keep my doctor?
• Are there meaningful differences in how insurance companies underwrite health insurance applications?
• What is health insurance trend (medical inflation)?
• How do PPO plans and HMO plans differ?
• How long does it take to enroll in a health insurance plan?
• Can my health insurance application be denied?
• Why should I use an independent health insurance agent?
• How do health insurance companies define "pre-existing condition?"
• Do I have to take a physical exam in order to obtain health insurance coverage?
• What are the options for making my initial health insurance premium payment?
• I am pregnant.  Can I obtain health insurance?
• Will a new health insurance policy cover my pre-existing condition?
• Will this website keep my personal information private?
• Do my health insurance premiums increase as I get older?
• Can my weight make a difference in my health insurance rates?
• For how long am I committed to keep any health insurance I purchase?

Can I buy health insurance for less if I deal directly with an insurance company?
No. Health Insurance rates are strictly regulated by the state.  Health insurance will cost the same whether you use an independent health insurance agent or deal directly with an insurance company.
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Must I pay a fee to an independent health insurance agent?
No. An independent health insurance agent is paid a commission by the health insurance company.  No additional fees are added to your health insurance cost
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I have previous group health insurance coverage.  Does this mean the health insurance company must accept my application and apply no pre-existing condition limitations?
No. In Texas it does not matter that you have previous group health insurance coverage.  A health insurance company can still deny your application for individual or family coverage.  However, if your application is declined, you may be eligible to participate in the Texas Health Risk Pool (www.txhealthpool.org ) established for persons who are unable to obtain health insurance coverage on the open market.
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What are my options if I my application for coverage is denied?
You can apply to another health insurance company.  Different insurance companies use different underwriting standards. You may obtain coverage the second time around.  It depends on the specific health conditions at issue.  If no health insurance company will agree to insure you, you may qualify for enrollment in the Texas Health Risk Pool (www.txhealthpool.org).
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Can my health insurance be terminated for any reason?
Texas provides strong consumer protection.  In general, the insurance company can terminate your coverage for only the following reasons: (1) failure to make premium payment within the payment grace period, (2) material omission or misrepresentation on your health insurance application, or (3) the insurance company entirely withdraws from the individual health insurance business in Texas.
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What is short-term health insurance?
Short-term health insurance is designed to fill temporary gaps in your "permanent" health insurance coverage.  These policies are relatively inexpensive and can go into effect very quickly.  Most short-term plans last for no more than six months.

You can purchase short-term health insurance coverage in one-month increments or in a single payment for one to six months of coverage.  All short-term plans exclude coverage for pre-existing conditions.  Some applicants who would be denied by insurance companies providing "long-term" or "permanent" health coverage are able to obtain short-term health insurance.
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What are "pooled" health insurance rates?
"Pooling" is the most common and, in our opinion, the fairest approach to setting health insurance rates.  A health insurance company operating under a pure "pooled" approach uses the same method in determining rates for both new and existing clients, regardless of the client's health status or claims history. 
In other words, insurance companies with "pooled" rates do not charge lower rates to entice new customers, while charging higher rates to long-time customers.

This issue has very important implications for people intending to be enrolled in a health insurance plan for more than a year.  Texas Health & Life favors health insurance companies using the "pooled" rating approach.
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Under a new health insurance plan, can I keep my doctor?
You should review a health insurance plan's physician network before applying to the plan. 
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Are there meaningful differences in how insurance companies underwrite health insurance applications?
Yes. For example, one insurance company assigns "preferred" rates to a 5'10" male who weighs 215 lbs.  Another insurance company would assess an additional 40% charge for this person.  One insurance company charges an additional 40% for smokers.  Another charges an additional 25%.  One might not charge a rate increase at all.  There are many distinctions such as these.  To get the best health insurance value for your own situation, you need the advice of a good health insurance agent.
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What is health insurance trend (medical inflation)?
Health insurance trend is an annual percentage increase in health insurance claim costs.  The two primary components of health insurance trend are (1) inflation of costs physicians and hospitals charge for health care services and (2) increases in the average utilization of these services.
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How do PPO plans and HMO plans differ?
The primary difference is that HMOs limit your non-emergency health care coverage to a limited network of physicians and hospitals.  PPO plans insure covered services delivered by any licensed physician or hospital, though a PPO plan will offer improved benefits if you use physicians and hospitals participating in the PPO's preferred network.

PPO networks are normally much larger than HMO networks, though HMOs provide higher benefit levels. For most individuals and families in Texas, PPO rates will be lower than HMO rates.  In addition, HMO plans are rarely an option for persons not participating in employer-sponsored programs.  The large majority of our individual and family health insurance clients enroll in PPO plans.
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How long does it take to enroll in a health insurance plan?
It depends on the health status of the applicant and the health insurance company to which the applicant applies.  Some health insurance companies may approve, within a few days, the application of a healthy young adult.  However, for less healthy or older applicants, processing of an application can take several weeks or more.  Each circumstance is different.  You should consult your independent health insurance agent to get a realistic expectation.
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Can my health insurance application be denied?
Yes. Whether an application is approved or denied depends on the applicant's health and the underwriting guidelines of the insurance company.  Contact your independent health insurance agent to get a realistic assessment regarding your own circumstance.
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Why should I use an independent health insurance agent?
Because he/she is not an employee of an insurance company, the independent agent can more objectively recommend the best health insurance company for your situation.  In addition, an independent agent will be familiar with insurance company bureaucracies, which can save you a lot of aggravation.  Further, if your circumstances change, an independent health insurance agent can recommend a more appropriate health insurance plan for you.
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How do health insurance companies define "pre-existing condition?"
Each health insurance company has its own specific wording.  However, the following statement is in line with most insurance company provisions:  "A pre-existing condition is a medical condition that would cause a normally prudent person to seek treatment during the twelve months prior to the beginning of coverage.
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Do I have to take a physical exam in order to obtain health insurance coverage?
The health insurance companies represented by Texas Health & Life rarely require physical exams.  The exceptions usually involve older applicants who have not consulted a physician in the last couple years.
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What are the options for making my initial health insurance premium payment?
An initial payment (usually one month of insurance premium) is required with your health insurance application.  Checks, money orders, credit or debit cards are usually acceptable.  Health insurance companies will not accept cash.
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I am pregnant.  Can I obtain health insurance?
No insurance company underwriting individual or family health coverage will agree to insure you while you are pregnant.  However, group health insurance plans will accept new enrollees who are pregnant.  So, if you are pregnant and have an opportunity to enroll in a group health insurance plan, take advantage.  Otherwise, you may wish to look into the Texas Health Risk Pool or Medicaid if you have a low income. 
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Will a new health insurance policy cover my pre-existing condition?
Most individual and family health insurance policies limit coverage for pre-existing conditions during the first nine to twelve months of coverage – sometimes longer.  However, the pre-existing condition exclusion period is waived to the extent that the applicant has "qualifying" prior group coverage.  This is a government-mandated requirement, though the health insurance company can still deny the application of someone whose health does not meet the insurance company's underwriting requirements.  However, the insurance company can still waive coverage of the condition altogether rather than outright decline coverage.  

In the absence of prior group coverage, some health insurance companies will waive their pre-existing condition exclusion for any health conditions listed on the application.  Most HMO plans do not have pre-existing condition exclusions, though HMO coverage is rarely available to people not participating in employer-sponsored plans.  In addition, when such HMO coverage is available, the rates tend to be quite high or the HMO can decline coverage all together.

You should fully discuss your pre-existing conditions with your independent health insurance agent before you submit a health insurance application
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Will this website keep my personal information private?
Yes.  What little personal information you may volunteer while visiting this website will not be distributed to any outside organizations -- including health insurance companies.  
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Do my health insurance premiums increase as I get older?
Yes.  As people get older they tend to have more health care expenses.  Correspondingly, health insurance companies providing individual coverage charge higher rates to older persons and lower rates to younger persons.  For example, the health insurance rate charged to a 50-year-old is typically more than twice the health insurance rate charged to a 25-year-old.
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Can my weight make a difference in my health insurance rates?
Yes.  All Texas health insurers use height/weight tables to make risk determinations.  People with "non-standard" height/weight ratios may be charged higher rates or refused coverage.  These height/weight standards vary from health insurer to health insurer. 
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For how long am I committed to keep any health insurance I purchase?
Health insurance is generally purchased in one month increments (short-term plans are an exception), so your commitment is typically one month at a time.  If you stop making health insurance payments, the insurance company will simply terminate your coverage.
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