is anybody here getting their health insurance through the Texas Health Insurance Pool?

[MrsBrady]

http://www.txhealthpool.org/

or anyone here work in health insurance, HR, or is a health insurance broker in Texas?

My husband's current employer does not offer major medical. Would be the perfect job if not for that.
I'm underemployed and haven't been able to find a full time position, and my part time has not turned into full time like it was promised.
Plus I'm still out sick recovering from a kidney infection. And, I may go back to school/grad school. I'm a musician with just a BA,
so yea, I know. Shoulda been a doctor. (I teased hubby that I could get pregnant to get coverage, and um..you probably know how that conversation ended
:rofl: Hey, gotta have some humor when shopping for health insurance, for realz. ok back to serious)

We are about to exhaust Cobra and due to pre-existing conditions...and in order to maintain continuous coverage (HIPPA),
I'm thinking that we are going to have to move to THIP. *thrilling* :eyes:
We can't afford to NOT be insured. 2014 can't come soon enough.

Still looking to see if there might be some private plans offering pre-existing coverage -- as I've heard some companies are getting ahead of 2014 to get the customers ahead of time..
anybody getting coverage through a private insurer thats covering pre-existing???
--Also my fear would be that even if we got coverage through a private insurer that was doing pre-existing that they could/might choose drop us? (is that still legal?)
..so I'm thinking the THIP is the way to go.

I've called the Department of Labor, they had me call the Employee Benefits Security Administration. I've already talked to the THIP a few months ago.

I do need to make one more phone call to my husband's former employer -- or former union rep, really I think would be my first choice - because I need to see if
our current group policy has a provision to convert to private coverage.

Looking for other DU'ers who can help here.

Thanks. :)

[MrsBrady]

1. also I'm getting mixed info regarding this info:

Under the federal Health Insurance Portability and Accountability Act, or HIPAA, your former employer's health insurance carrier has to offer you an individual medical insurance plan after COBRA coverage expires
Typically, the insurer that continued your health benefits via COBRA will mail you a letter explaining HIPAA coverage options.
There's nothing to preclude you from shopping for a private health insurance plan with another insurer that may cost less or better suit your needs. However, the HIPAA protections allow you to buy a plan from your former employer's health insurance carrier that has no expiration date like the COBRA plan, meaning you can keep the coverage as long as you need it, provided you pay the premiums.
In addition, your former employer's health insurance company must cover any pre-existing medical conditions, something not true of other private plans.
http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/what-to-do-when-cobra-runs-out.aspx

and here

Conversion Options
If your group health plan gives participants and beneficiaries whose coverage under the plan terminates the option to convert from group health coverage to an individual policy, the plan must give you the same option when your maximum period of continuation coverage ends. The conversion option must be offered not later than 180 days before your continuation coverage ends. The premium for an individual conversion policy may be more expensive than the premium of a group plan, and the conversion policy may provide a lower level of coverage. You are not entitled to the conversion option, however, if your continuation coverage is terminated before the end of the maximum period for which it was made available.
http://www.dol.gov/ebsa/publications/cobraemployee.html


so is this true or not?????

[MrsBrady]

2. ok -- I called the CHAP department in Austin

I called the CHAP people. The guy I talked to was uber uber helpful. Really knowledgeable and friendly.

http://www.texashealthoptions.com/cp/index.html
Get Help: 1-855-TEX-CHAP (1-855-839-2427)

Ok so - some things I need to do after talking with him.

1) Find out if my husband's former employer/insurance offers a complete conversion plan. He said it's rare and they probably don't. But at least find out, he said.

2) If my husband's former company was self insured, then we cannot get STATE CONTINUATION coverage of cobra. If they are not, then we can. He said our company is probably self insured, but we
should call and ask.

3) He said with continuation coverage, which we have, we can go to the private market and get insurance and they have to cover your pre-existing. Price and benefits TBD, of course.
But he said you can at least get it. He said this is new.

4) or go into the Texas Health Insurance Pool.

He said he was not endorsing this, but he knows some people are waiting the 6 months out and going into the new federal PCIP
https://pcip.gov/

Also, he said price everything out, get prices from a bunch of different places, think about what we want to do,
then call him back and he would help me figure out which one was better/cheaper - and answer any questions I had. Even said to ask for him by name, if I wanted.

So at least I have a starting point.

If anyone has anything to add, let me know.

[kjackson227]

5. Hi, Mrs.Brady...

There aren't very many options for us here in Texas that I'm aware of. But, I do know that the Texas Health Pool is pretty high.

Have you taken this consumer test that's on the Healthcare.gov website?

http://finder.healthcare.gov/?state=TX&x=16&y=11

Since there are so many links, you have to try all of them until you can find one to fit your situation. HTH :)

[MrsBrady]

6. because we have have had continuous coverate

we WILL be able to get private health insurance, regardless of pre-existing (this is the part that is new).
it's just going to be a matter of cost and coverage. or the texas health pool, if we have to.

I'm familiar with that site. thank you :)

The texas state CHAP people have been very helpful
(they were created as part of the money provided from the health care law to the states, mandating that they provide
people with some real help in figuring out what to do in their situation)
I highly recommend them.


the chap guy told me to call him back after I get a bunch of quotes to make sure I understand what we're getting.
and you bet that I will.

[MrsBrady]

3. I really have to sing the praises of the CHAP people

He even called me back this morning to see if I had any questions. And to let me know to call him back when I do.

Wonderful. Wonderful. Wonderful.

[Melissa G]

4. Do you play music professionally?

The Musician's union has a plan if you are a member and you can get your whole family covered. That is what we use.
PM me if you need more info.

[Schema Thing]

7. I'd look seriously at going w/o for six months. if at all possible.

then get into the state pre-existing plan.


It's priced as good or better than group insurance on the open market as of June 2011.

[MrsBrady]

8. yea, I saw the prices - was kinda impressed.

my husband doesn't "get it" though.
and I'm still sick.

Maybe when I show him the numbers it will sink in....

kinda like when he wanted even just to have a small wedding and I told him we should elope....he didn't like the idea
of eloping until I started pricing out flowers, food, music, dresses, tuxes, etc...and showed him the budget for
even a small/modest wedding. egads.

we'll just have to see. thanks.


on edit: just fyi, the new pre-existing plan for uninsured Texans, per the new health care law is run by the feds.
It varies from state to state, though, weather it's federally run or state run.
Texas does have it's own state run health pool, but that's something different.