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Your Online Guide » Guide to Insurance » Individual Health Insurance Coverage

[H181]Health Insurance Texas Individual
by Melih Oztalay, Mel
Health insurance. Everyone needs it, but not everyone has it. And with medical expenses on a seemingly endless rise, paying out-of-pocket for them could land you in the poor house. So when choosing a health insurance plan, it's good to know the basics to help you make better, more financially sound choices when selecting a plan.

Health insurance plans generally fall into one of three categories: indemnity plans, also known as reimbursement plans, preferred provider plans (PPOs), and managed care plans (HMOs).

An indemnity plan allows you to choose your own doctors and it completely pays for your medical expenses, either in full or according to a schedule of benefits. The schedule of benefits may be substantially less than your actual costs. Preferred provider plans and managed care plans can provide broader coverage, but they involve an arrangement between the insurer and a specified network of health-care providers. In addition, managed care plans require pre-approval of many health care services. For example, an HMO may require that a primary care physician in its network coordinate all of your care as well as refer you to specialists that belong exclusively to the network.

No matter which kind of health insurance you buy, make sure it provides you with the right kinds of coverage. And when it comes to coverage, a good health insurance plan should offer several types. For example, hospital expense insurance pays room and board as well as incidental services costs if you're hospitalized. A surgical expense insurance covers surgeons' fees and all other related costs. A physicians' expense insurance policy pays for visits to a doctor's office or when a doctor's visits you in the hospital. Finally, major medical insurance offers very broad coverage with an extremely high maximum benefit that's designed to protect you against losses due to serious illness or injury.

So what might be covered in a health insurance plan? When comparing plans, make sure they provide additional benefits that you may need, including:
o Prescription drugs
o Preventive care
o Mental health benefits
o Maternity care
o Vision care

And what can all this cost? In addition to the monthly premium expense, there may be other out-of-pocket expenses that can really add up, especially if you have children or other family members who make frequent visits a doctor. You should check to see if the health insurance plan you're considering asks you to pay any or all of the following:
o Co-payment The amount paid for each visit to a health insurance provider. This is generally required by HMOs.
o Deductible The amount paid toward your medical expenses, most probably annually, before the insurance company pays any claims. This is generally required by indemnity plans.
o Coinsurance The percentage of your medical costs paid after reaching any applied deductibles.

Now that you've established the why and what of health insurance, you need to find out where you can get it. Health insurance can be acquired through a group plan at work or through a group affiliation, such as a school, a club, association, etc. Or you can purchase an individual plan. When buying an individual health insurance plan, you can most probably customize it for your particular needs. If you're looking for an individual plan, start by going online to compare coverages and rates from a number of companies to find the best plan and rate that meets your needs.

You now know the what's, why's and where's of the health insurance game. Your next step is to select the best health insurance plan that meets your needs. You should select one that gives you the greatest flexibility and the best benefits for the lowest cost. Since this is a major purchase, you should shop around and get several quotes before choosing a plan. But before you dive in, here are a few things to consider:

1. Co-pays, deductibles, and coinsurance requirements, which ones apply?
2. Do you have the freedom to choose your own health-care providers?
3. Does the plan you're considering cover the health services you need?
4. Does the plan you're considering work with the health-care providers you're currently using?
5. Does the plan you're considering offer family, and individual, coverage?
6. Does the plan you're considering cover pre-existing conditions? If so, is there a waiting period? FYI - The average waiting period can be three months to one year.
7. Does the insurance company you're considering have a good reputation and a positive rating from a major ratings organization? For more information, contact your state's department of insurance.

If you live in the state of Texas and for whatever reason you lose your group health insurance coverage (via your employer), you will still be able to have health coverage. However, you will be paying more because your employer will not be paying into it. Health insurance in Texas is mandated by health coverage called COBRA. COBRA stands for Consolidated Omnibus Budget Reconciliation Act. This alternative health coverage is mandated by the federal government and is to be used in the event you are no longer employed.

The way it works is you would pay more than you would if you were still an employee of a company. You would continue coverage for you and your family. This kind of health insurance in Texas can help you keep health benefits for you and your family. With COBRA, you are allowed coverage for 18 months and for your spouse and dependents, they are allowed health insurance coverage for twice as long. This alternate health plan is basically used when an employee is not longer employed.

COBRA is used where companies have more than 20 employees. If an employee is disabled or uses Medicare, the rest of their family is allowed to use COBRA. There is a window of 60 days to give you time enough to decide whether or not you want to use the alternative health care coverage. If you decide to get this health insurance in Texas, payment of the full premium is required along with a fee.

In the state of Texas, if you wish to continue your HMO health insurance, through COBRA, you can do so. However, since it only covers certain areas, you would have to stay in the designated area in order to get the benefits. Otherwise, you will only get coverage for emergency services. Having COBRA as health insurance in Texas may be more costly, but it's better than not having any health insurance at all.

In the state of Texas, there is a law that discusses a continuation period. This period lasts for about half a year. This continuation period starts when your COBRA coverage stops. If you can get the continuation, but prefer COBRA instead, then you will have two years to get health care insurance.

State law mandates that health insurance carriers are to make available a group continuation privilege for those who no longer have the alternate insurance. The person should have been covered under the group contract. With this kind of health insurance in Texas, the group insurance coverage won't stop until after there is evidence that no payment has been made.

There is another alternative health insurance in Texas. The state uses what is called the Health Pool. For those who can't get health insurance coverage because of a pre-existing condition or related chronic illness, they can use this health coverage. They have coverage for major medical procedure. The amount you pay depends on several factors: age, gender and where you live. Depending on these factors, the insurance carrier will tell you how much you would be paying. So whatever your situation in regard to getting alternative health insurance is, you should be able to find something that can get.

Article Source : Tricare Supplement

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Both Melih Oztalay & Jordan Feross are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Melih Oztalay has sinced written about articles on various topics from Modelling, Site Promotion and PPC Advertising. Melih ("may-lee") Oztalay, CEOSmartFinds Internet MarketingWeb: EMail: melih@hsfideas.comPrecedent - Health Insurance For The Rest Of Us. Melih Oztalay's top article generates over 90500 views. to your Favourites.

Jordan Feross has sinced written about articles on various topics from Real Estate, Health Insurance and Credit Loans. This article about is brought to you by Texas Health and Jordan FeRoss. You need to check out their website:. Jordan Feross's top article generates over 165000 views. to your Favourites.
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