Notice of Availability of Coverage Under the Texas Health Insurance Risk Pool, §§21.2305 Form

 

FIGURE 1

 

NOTICE OF AVAILABILITY OF COVERAGE UNDER THE

TEXAS HEALTH INSURANCE RISK POOL

This notice is to advise you that you may be eligible for coverage from the Texas Health Insurance Risk Pool (Health Pool).

• To be eligible for Health Pool coverage, you must have documentation of at least one of the following:
• a written refusal or rejection, based on health reasons, by a health carrier, for substantially similar individual hospital, medical, or surgical coverage.

• a certification from an agent or salaried representative of a health carrier on the Health Pool’s certification form, stating that the agent or salaried representative is unable to obtain substantially similar individual hospital, medical, or surgical coverage for you from a health carrier the agent or salaried representative represents because, based on that health carrier’s underwriting guidelines, you will be declined for coverage as a result of a medical condition.

• an offer of substantially similar individual hospital, medical, or surgical coverage with riders excluding certain health conditions you have (For example, a health carrier will provide coverage to you with an exclusion of coverage of your diabetes, heart disease, cancer, etc.).

• a rate quote from a health carrier offering to provide substantially similar individual hospital, medical, or surgical coverage at rates that are higher than the rates of the Health Pool.
• diagnosis of one of the medical conditions specified by the Texas Health Pool Board of Directors.
• proof that health coverage has been maintained for the previous 18 months with no gap in coverage greater than 63 days, with the most recent coverage with an employer-sponsored plan, government plan, or church plan.

For additional information concerning eligibility, coverages, cost, limitations, exclusions, and termination provisions, call or write:

Texas Health Insurance Risk Pool
P. O. Box 6089
Abilene, TX 79608-6089
1-888-398-3927
www.txhealthpool.com

 

Hearing and speech impaired users may call: 1-800-735-2989.

This is the number for Relay Texas.
(A public service of the Texas Public Utility Commission.)

 

Health Pool Notice

For more information contact: LifeHealth@tdi.state.tx.us