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> Finding Health Insurance Online
Posted On: 11/13/2006 12:37:46 PM
Filed Under: Insurance > Health Insurance
Finding Health Insurance Online
Looking for health insurance has never been easier. The Internet provides a fast and easy way to find the plan you are looking for. Now you’re able to compare rates and policies in a matter of minutes.
Through services like SPENDonLIFE.com you can get multiple quotes so that you can compare your health insurance options. Below are some things you should know before continuing your research.
- Do employers have to provide health care coverage?
No. If a business does offer health care coverage, certain state and federal regulations may apply. Even if health benefits are offered, certain requirements, such as full-time status, may be imposed and the employer may impose a waiting period for all new employees before coverage is effective. That period may extend up to 90 days for small employers. Large employers have no limit on the length of the waiting period.
Eligible employees for small and large employer plans are those who:
- Usually work at least 30 hours a week
- Do not have coverage under another group health benefit plan
- Are not classified as temporary or seasonal workers.
A count of eligible employees is used to determine whether an employer is classified as a small employer or a large employer.
- Do insurance companies and HMOs have to accept everyone?
It depends. Insurance companies and HMOs do not have to accept everyone who applies for coverage.
With small employer health plans, state and federal laws now provide guaranteed issue protection. That means if an insurance company or HMO sells small employer coverage, it may not refuse to cover small employers who have employees with health problems. Under small employer plans, all eligible employees, and their dependents, must be offered coverage. In addition, group members cannot be excluded for health reasons. Health status may be screened, but only to determine the appropriate premium rates for the group.
Insurance companies and HMOs who offer large employer plans and valid self-funded ERISA plans have to accept the entire group or reject the entire group. Once they accept a group, no member of that group may be excluded.
Large employers, including those with valid self-funded ERISA plans, are permitted to determine which class of employees (if any) is eligible for coverage. For example, they may offer health plans to executive employees only. Once coverage is offered, however, the insurer or HMO must accept all or reject all employees in that class. They may not exclude any employee because of health status. The health history of the large employer’s group of workers (and dependents, if dependent coverage is offered) may be screened, but only to determine whether to accept or reject the entire group or what premium rate to charge the entire group.
Note: Insurance companies and HMOs that provide small and large employer health coverage must give policyholders and TDI 90 days advance notice before discontinuing a plan. The insurance companies and HMOs also must offer at least 90 days prior to the discontinuation to replace the discontinued plan with any other plan being offered to small or larger employers.
- What can I do if I can’t afford or find health care coverage? (specific to Texas)
Several alternatives to the usual individual and group health care plans are listed here.
The Texas Health Insurance Risk Pool (Health Pool) is a plan specifically for uninsurable persons and their dependents or family members and for certain individuals who lose their employer-sponsored health coverage. The premium rates may be up to twice the standard rate in the individual health insurance market.
- The Health Pool offers an individual PPO major medical policy, with three deductible options. The policy provides benefits for both hospital stays and physicians´ services in and out of the hospital.
- Benefits include coverage for prescription drugs and coverage for serious mental illness, subject to calendar year maximums for inpatient and outpatient treatment of serious mental illness. No benefits are provided for alcoholism or substance abuse.
An individual eligible for Health Pool coverage is a legal resident of Texas under age 65 who
- Has maintained health coverage for the 18 months prior to application with the Health Pool, with no gap in coverage greater than 63 days, provided the last coverage was through an employer-sponsored plan, church plan, or government plan. An individual must apply for Health Pool coverage before the 64th day to automatically qualify for coverage. (Note: U.S. citizenship is not a factor in this method of qualifying for Pool coverage.)
- Or is a legal resident of Texas for at least 30 days and a citizen of the United States, or a permanent resident of the United States for at least three continuous years, who:
- is rejected for substantially similar individual health insurance for health reasons
- is unable to find substantially similar individual health insurance except at rates higher than those charged by the Health Pool or with an exclusion for a health condition
- is a dependent of an adult covered by the Health Pool
- is a family member who resides with a child covered by the Health Pool
- is certified by an agent as unable to be accepted for substantially similar individual health coverage by a licensed insurance company or HMO represented by the agent due to medical condition or
- has one of the medical conditions that automatically qualify a person for coverage (the list is available from the Health Pool).
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