Health Reform Is Changing Individual Health Insurance

Some of the earlier required changes applicable to individual health insurance Texas policies go into effect for new policies on September 23rd. Many businesses, however, will not have open enrollment until January 1, 2011; so many employees will not see new policies until that time. However, if you enroll in a new individual health insurance Texas policy after September 23rd, you will notice the following changes in effect.

Young adult dependents will be permitted to remain covered under their parents’ individual health insurance Texas policy until age 26. They are not required to stay part of their parents’ parents’ individual health insurance Texas policy, but they are allowed to if they cannot access their own health care coverage either through an employer-based group plan, or an individual health insurance Texas policy.

Children can no longer be denied coverage by an insurance provider due to a pre-existing condition when applying for an individual health insurance Texas policy. This provision will apply to adults in 2014. There is a lot of debate as to whether this requirement will result in individual health insurance Texas plan premiums increasingly an exorbitant amount, or whether the influx of paying health insurance plan members will offset this risk to insurance providers.

Insurance carriers who approve an applicant’s individual health insurance Texas policy can not rescind coverage after that person becomes sick. This will be considered illegal after September 23rd. This includes looking for errors on the member’s individual health insurance Texas policy application to deny payment once claims have been filed and submitted.

New individual health insurance Texas policies will be mandated to include certain preventive services, such as mammograms, immunizations, and colonoscopies, without requiring the member to pay a deductible, or coinsurance portion. This is not required of current active individual health insurance Texas policies, but if you change policies, then it will be mandated of the new individual health insurance Texas plan.

Lifetime limits on benefits will not be allowed on new individual health insurance Texas policies, as applied to essential medical care, such as hospital stays or expensive medical treatments. For example, if you have cancer, the insurance carrier cannot impose a limit on how much they will cover of your medically necessary treatment.

Future individual health insurance Texas policies will allow pediatricians and obstetrician/ gynecologists to be considered primary care physician, and therefore patients will not have to seek referrals or prior authorization to see these types of health care providers.

Emergency medical care benefits will also be protected in future individual health insurance Texas plans. For example, insurance carriers cannot require prior authorizations for emergency room services, and they are also prohibited from charging higher coinsurance because emergency room medical services were provided by an out of network provider. This protects members from outrageous charges when an emergency occurs.

A final change that occurs in September is that insurance carriers will have to implement new processes for members to file appeals when a claim has been denied. For example, insurance carriers will have to continue making payments while the appeals process is going on