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TEXAS RISK POOL - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Texas health insurance risk pool or THIRP.

Regulation establishing risk pool: Texas Legislation under Senate Bill 467.

Funding: The programme receives funds from premium payments by members. Funds are also received from assessments on health plans of companies with no tax offset.

Plans offered: Three medical plans are offered through THIRP. All plans are PPO plans with three different deductibles.

Plan benefit: PPO plans offer deductibles of $1000, $2500, and $5000. The in network medical covers are offered at a coinsurance level of 20%. The member is expected to pay 20% coinsurance rates for out of network services. The $1000 deductible plan has and the out of pocket maximum is $4000. The $2500 deductible has an out of pocket limit of $5500. The $5000 deductible plan has a maximum out of pocket is $8000.

THIRP plan summary: http://www.txhealthpool.com/benefits.html.

Maximum benefit limits: Contact the pool for information on this facility.

Eligibility: (1) The person under 65 and a resident of Texas you should provide proof of the fact that you had suitable covers for at least 18 months before your application. (2) The gap in insurance cover should not have been more than 63 days. (3) The person should have been without health cover for at least a period of six months prior to applying for covers. (4) You must be below the age of 65 and be eligible for Trade Adjustment Assistance of The Pension Benefit Guarantee Corporation. You can provide proof of any one of the following: (a) You have received a notice rejecting your application for insurance because of medical reasons. (b) You were not able to obtain insurance because of a pre existing medical clause.

Enrollment periods: The enrollment period for THIRP are not fixed. A person conforming to the eligibility criteria may apply for covers at any time. Coverage usually starts on the first of the following month.

Premium payments: Your age, gender, tobacco usage and plan selection determines the premium you pay.

Premium calculations: The rate capped is 200% of the standard rate charged by the leading insurance companies in the state.

Pre existing condition waiting period: A waiting period of 12 months is provided for a person with a pre existing condition. It is waived for prescription a person with 12 months of continuous coverage that was not ended before 63 days prior to the application.

Contact information: Texas Health Insurance Risk Pool. Po Box 6089. Abilene, Texas 79608. Phone- 8883983927. THIRP Website.

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