- Health Insurance Information from Texas Department of Insurance
Public Data Lookup for Health Maintenance Organization (HMO), Regulated Companies, State Fire Marshal's Office, and Utilization Review Agents (URA), eDisaster, Market Connection, IRO Requests Form, TDI Claims Data Reporting, Windstorm WPI-8 Certificate Search, Search for Company Profile, TDI Public Account Management - Unavailable beginning November 9, 2012, at 6:30 p.m. until November 12, 6:00 a.m. CST.
Health Insurance
NEW! - Information regarding rate increase filings subject to Federal Health Reform
Highlights
Healthy Texas
- A Private / Public Health Insurance Planand part of a new statewide health insurance program designed for small business owners and their employees.
- A service of the State of Texas - with links to government & other Web sites to help Texans shop for health insurance.
Texas Health Insurance Pool
- An individual health insurance program created by the Texas Legislature to provide health insurance to Texans who cannot obtain coverage because of a medical condition or HIPAA-related health insurance portability issues.
- Premium subsidy application form for enrollees whose household incomes are at or below 300 percent of the federal poverty level.
- Texas Health Insurance Pool Publication (PDF)
More Health Insurance Information
- A number of health insurance publications are available.
- Accident and Health staff also provide a number of web resources for consumers, as well as checklists and data for insurers with accident and health policy forms.
- Complaint Information
- TexasHealthOptions.com - A service of the State of Texas - with links to government & other Web sites to help Texans shop for health insurance
- Mediation for Out-of-Network Hospital-based Health Care Provider Claims
- Consumer Complaint Information
- Texas Mandated Benefits/Offers/Coverages
- LHL Advisory Committees and Stakeholder Groups - Includes CEDE and TACCP Meeting Information
| Help For | Toll-Free # |
|---|---|
| Consumers | 800-252-3439 |
| Injured Workers | 800-252-7031 |
| Reporting Arson | 877-434-7345 |
| Reporting Fraud | 800-252-3439 |
| Safety Violations | 800-452-9595 |
| [ tdi phone listings ] | |
| Help For | Link |
|---|---|
| Agents / Adjusters | |
| Filing Complaints | |
| Health Providers | |
| Media / Others | |
| Website Problems | |
| Favorite Links | |
|---|---|
| Agent Lookup | Company Lookup |
| Enforcements | DWC Home |
| DWC Forms | All Other Forms |
| TDI Jobs | TXCOMP Home |
| TDI StormLink | Windstorm |
| [ popular links · more lookups ] | |
For more information contact: ConsumerProtection@tdi.state.tx.us
Last updated: 10/15/2012
Contact Information and Other Helpful Links
Translation by WorldLingo
Español
For other local options visit TexHealth.org
Healthy Texas - Health Insurance for Small Businesses
Healthy Texas has reached its enrollment limit and carriers are not accepting new groups.
Learn more about the Healthy Texas enrollment limit.
Learn more about the Healthy Texas enrollment limit.
Participating Carriers:
Visit Celtic's Healthy Texas page
1-877-779-5229
Visit UnitedHealthcare's Healthy Texas page
1-866-438-5588
For other local options visit TexHealth.org
Stay Informed
 Can't find health insurance? The Texas Health Insurance Pool can help. to the Governor Log into Blue Access for Members to Manage Your Medical Benefits and More Log into www.medco.com to Manage Your Drug Benefit and More Tip: When registering, enter only your 9-digit numeric ID# in the Member Number field Policy Sample (Standard Plans I-IV) Effective 01/01/2012 Policy Sample (High Deductible Health Plan /HSA-Qualified Plan V) Effective 01/01/2012 CLICK HERE
| 
POOL ENROLLMENT AS OF OCTOBER 2012: 23,289
TOTAL TEXANS ENROLLED SINCE INCEPTION: ±90,000
|
- BlueExtrasSM Use your Pool ID card to take advantage of discounts on health and wellness services, including vision, hearing, weight management and vitamins. For more information, log into BlueAccess for Members, click the 'My Health' tab, and then the 'BlueExtras Discount Program' link.
Please note that documents in Adobe Reader (pdf format) require
a recent version of the free software. Use the link below to download:
Public Data Lookup for Health Maintenance Organization (HMO), Regulated Companies, State Fire Marshal's Office, and Utilization Review Agents (URA), eDisaster, Market Connection, IRO Requests Form, TDI Claims Data Reporting, Windstorm WPI-8 Certificate Search, Search for Company Profile, TDI Public Account Management - Unavailable beginning November 9, 2012, at 6:30 p.m. until November 12, 6:00 a.m. CST.
Health Related Publications
Chinese (traditional) Versions
English Versions
- Healthy Texas - (PDF)
- Long-Term Care Insurance Rate Guide - (HTML)
- Texas Health Insurance Pool - (PDF)
- Understanding Annuities - (HTML)
- Your Health Care Coverage - (HTML)
- Disability Management Overview - (PDF)
- Medical Forms - (PDF)
- Average Weekly Wage Calculations - (PDF)
- Death and Burial Benefits - (PDF)
- Lifetime Income Benefits (LIBs) - (PDF)
- Prescription Reimbursement - (PDF)
- Temporary Income Benefits (TIBs) - (PDF)
- Workers' Compensation Benefits - (PDF)
- Workers' Compensation in Texas - (PDF)
- WorkingTogether for a Healthy Texas - (WORD)
- SARS Factsheet - (PDF)
- Aging in the Workplace - (PDF)
- Allergies - (PDF)
- Chickenpox FactSheet - (PDF)
- Chlorine - Take 5 for Safety - (PDF)
- Fluid Replacement FactSheet - (PDF)
- Flu/Influenza Take 5 for Safety - (PDF)
- Foodborne Diseases - (PDF)
- Footwear Safety FactSheet - (PDF)
- Gastroenteritis FactSheet - (PDF)
- Hand Hygiene FactSheet - (PDF)
- Hypothermia FactSheet - (PDF)
- Influenza FactSheet - (PDF)
- Latex Allergy - (PDF)
- Latex Allergy FactSheet - (PDF)
- Proper Use of a Respirator - (PDF)
- SARS FactSheet - (PDF)
- Sleeping Restfully - (PDF)
- Smallpox FactSheet - (PDF)
- Stress Reduction Fact Sheet - (PDF)
- Stroke Prevention FactSheet - (PDF)
- Sunglasses Safety - (PDF)
- Tuberculosis - (PDF)
- Tuberculosis FactSheet - (PDF)
- West Nile Virus FactSheet - (PDF)
- West Nile Virus Mosquito Control - (PDF)
- Workplace Wellness Factsheet - (PDF)
- X-Ray Machine Safety FactSheet - (PDF)
Korean Versions
Spanish Versions
- Ayudándolo con sus Quejas de Seguros - (HTML)
- Redes de Servicios Médicos de Compensación para Trabajadores: Información para Empleados Lesionados - (HTML)
- Su cobertura de cuidado de salud - (HTML)
- Beneficios de por vida - (PDF)
- Reembolso por Recetas Médicas - (PDF)
- Avoid the Flu Take - (PDF)
- Bloodborne Pathogens - (PDF)
- Common Cold Fact Sheet - (PDF)
- Hand Hygiene FactSheet - (PDF)
- Office Ergonomics - (PDF)
- Proper Use of a Respirator - (PDF)
Vietnamese Versions
Contact Information and Other Helpful Links
Translation by WorldLingo
Public Data Lookup for Health Maintenance Organization (HMO), Regulated Companies, State Fire Marshal's Office, and Utilization Review Agents (URA), eDisaster, Market Connection, IRO Requests Form, TDI Claims Data Reporting, Windstorm WPI-8 Certificate Search, Search for Company Profile, TDI Public Account Management - Unavailable beginning November 9, 2012, at 6:30 p.m. until November 12, 6:00 a.m. CST.
Accident and Health
- Product Checklists
- Companies offering Long Term Care Insurance
- Long Term Care Consumer Disclosure Form
- Consumer Choice Health Benefit Plans Resources
- PPO contract Provisions
- Dental contract Provisions
- Individual Health contract Provisions
- Medical Savings Account (MSA) contract Provisions
- Health Savings Account (HSA) contract Provisions
- Certifications
- Chapter 26 Health Insurance Portability and Availability Act Regulations Small Employer Section; Large Employer Section (use your browser's "Back" key to return to TDI).
- Carriers offering coverage in the Mid-Size and Large Employer Market
Contact Information and Other Helpful Links
Translation by WorldLingo
SKIP TO CONTENT
Texas Health Options
This site is a State of Texas resource for finding health insurance coverage.
Profiles:
- Parent or Guardian
- Parent–Child Medical Support
- Senior
- Individual
- College Student
- Person with a Disability
- Unemployed
- Military Servicemember
- Small Business Employer
- Large Business EmployerParent or Guardian
Programs:
- CHAP - Do you have a health insurance question or concern?
- Healthy Texas - Affordable Coverage for Small Business Owners
- Federal Health Reform - Affordable Care Act information
Learn about Insurance:
- Glossary
- Your Health Care Coverage
- HMOs
- Long-Term Care Resources
- Senior Information
- MSAs / HSAs
- About Discount Cards
Find Coverage:
- Using an Agent
- Consumer Choice Plans
- Individual Health Plans
- Mid-Sized & Large Employer
- Small Employer
- Cooperatives and Coalitions
- Medicare Health Plan Finder
Public Data Lookup for Health Maintenance Organization (HMO), Regulated Companies, State Fire Marshal's Office, and Utilization Review Agents (URA), eDisaster, Market Connection, IRO Requests Form, TDI Claims Data Reporting, Windstorm WPI-8 Certificate Search, Search for Company Profile, TDI Public Account Management - Unavailable beginning November 9, 2012, at 6:30 p.m. until November 12, 6:00 a.m. CST.
Physicians & Health Providers
This is the Physician/Provider webpage on the TDI website. This page is designed to assist physicians and other health care providers find information related to the prompt payment of claims, the filing of complaints, and credentialing for fully insured health plans. In addition, this page will provide links to helpful information on workers’ compensation insurance, medical malpractice, and professional liability insurance. Note that the prompt pay and credentialing resources on this page do not apply to workers’ compensation insurance.If you are a consumer, please see our consumer page for more information. If you are looking for a particular provider in your health plan network, please consult your insurance carrier for a list of participating providers.
Rules Update for Preferred Provider Plans in Texas
On May 15, 2011, the Commissioner of Insurance adopted rules relating to preferred provider plans (PPPs) including definitions of network adequacy and new requirements for cost transparency.Following is a brief summary of these rules:
28 TAC §§3.3701 - 3.3711 and 3.3713 Preferred Provider PlansAdopted May 15, 2011; effective May 19, 2012. The rules establish:
- Criteria for adequate networks that are similar to those for health maintenance organization (HMO) networks and tailored to meet the needs of the insureds in a geographic area. Networks must now contain enough doctors, hospitals and other providers to provide the full array of plan benefits within a prescribed drive time;
- “Approved Hospital Care Network” designations for compliant plans and “Limited Hospital Care Network” designations for others;
- Criteria for selection, credentialing, and retention of preferred providers based on national standards;
- Basic reimbursement standards for out-of-network claims, also aimed at reducing balance billing.
- Consumer notices when out of network referrals are made;
- Consumer information about network facilities, including the likelihood of balance billing occurring at such facilities;
- Disclosure of how out of network claim payments are calculated and the carrier’s average negotiated rates; and
- Real time estimates of payments to out of network providers.
The text of the latest adopted rules is available at: http://www.tdi.state.tx.us/rules/2011/documents/3-3701-3-3713fi.pdf
The Commissioner previously adopted rules relating to transparency of PPP health care reimbursement rate information. The text of these rules is available at: http://www.tdi.state.tx.us/rules/2010/documents/21.4501-21.4507.pdf
Provider Quick Links
Chiropractors Resource · Pharmacists Resource · Consumer Health PublicationsProvider Resources
Complaints - includes links to information about avoiding filing errors, reporting to the proper agency and filing justified complaints.
Prompt Pay - includes links to frequently asked questions, TACCP meeting notes, and guidelines.
Professional Liability - includes links to JUA, professional liability admitted carriers and medical malpractice information.
Prompt Pay - includes links to frequently asked questions, TACCP meeting notes, and guidelines.
Professional Liability - includes links to JUA, professional liability admitted carriers and medical malpractice information.
- Provider JUA
- Medical Malpractice
- Professional Liability Admitted Carriers
- Medical Malpractice Insurance Overview and Discussion (PDF)
Rules - includes links to Rules and Proposed Rules.
Enforcement - includes links to enforcement actions and unauthorized insurance plans.
Education Resources - includes links to workshop handouts, as well as SB 418, HB 610, "clean claims" and "prompt pay" materials.
Enforcement - includes links to enforcement actions and unauthorized insurance plans.
Education Resources - includes links to workshop handouts, as well as SB 418, HB 610, "clean claims" and "prompt pay" materials.
Credentialing - includes links to the credentialing application and information on how to complete.
Helpful Information - includes links to news releases, provider news, HMO patient notice, forms and reports.
Workers' Compensation - includes Workers' Compensation related links.
Helpful Information - includes links to news releases, provider news, HMO patient notice, forms and reports.
Workers' Compensation - includes Workers' Compensation related links.
Highlights
Prompt Pay
- Link to frequently asked questions about various "prompt pay" issues.
Credentialing Application
- Links to the credentialing application and information on how to complete it.
Professional Liability
- List of professional liability admitted carriers and other medical malpractice information.
Forms · Publications
| Help | Toll-Free # |
|---|---|
| Consumers | 800-252-3439 |
| Injured Workers | 800-252-7031 |
| Report Arson | 877-434-7345 |
| Report Fraud | 800-252-3439 |
| Safety Violations | 800-452-9595 |
| [ tdi phone listings ] | |
| Help | Link |
|---|---|
| Agent/Adjuster | |
| File Complaint | |
| Health Provider | |
| Media/Others | |
| Website Problems | |
| Favorite Links | |
|---|---|
| Agent Lookup | Company Lookup |
| Enforcements | DWC Home |
| DWC Forms | All Other Forms |
| TDI Jobs | TXCOMP Home |
| TDI StormLink | Windstorm |
| [ popular links · more lookups ] | |
For more information contact: LHLMgmt@tdi.state.tx.us
Last updated: 03/22/2012
Contact Information and Other Helpful Links
Translation by WorldLingo
Public Data Lookup for Health Maintenance Organization (HMO), Regulated Companies, State Fire Marshal's Office, and Utilization Review Agents (URA), eDisaster, Market Connection, IRO Requests Form, TDI Claims Data Reporting, Windstorm WPI-8 Certificate Search, Search for Company Profile, TDI Public Account Management - Unavailable beginning November 9, 2012, at 6:30 p.m. until November 12, 6:00 a.m. CST.
Life, Health and HMO
Highlights
- LIFE Home Page - How to Trace an Old Life Policy and other information about life insurance and annuities
- HEALTH Home Page - Accident and Health
- HMO Home Page - Find An HMO - Look for an HMO in your county or look over an HMO profile or report card. HMO financial reports and complaint data also are available.
More Related Links - Consumers
- Bulletin on Federal/State Laws that Regulate Union and ERISA Plans
- Health Cooperatives and Coalitions
- Health Maintenance Organizations (HMOs)
- HIV Consent Form(.pdf format)
- Federal HIPAA Information
- Independent Review Organizations (IROs)
- Life, Annuity and Credit
- Texas Mandated Benefits/Offers/Coverages
More Related Links - Industry
- Life and Health Data Calls
- Utilization Review Agents (URAs)
- LHL Technical Advisory Committees
- Medicare Advantage Marketing Guidelines and Resource Page – New rules, bulletins and other information for the industry and agents involved in marketing Medicare Advantage plans.
- Milliman & Robertson Cost Impact Study of Mandated Health Benefits in Texas / Report #1 - 2000 (Adobe PDF)
- Milliman & Robertson Cost Impact Study of Mandated Health Benefits in Texas / Report #2 - 2000 (Adobe PDF)
- Myths & Reality - Tips for Faster Policy Review. (Excerpts from Reprint of Texas Insurance News Article, June 1998.)
- Texas Mandated Benefits/Offers/Coverages
- 2002 Life/Health - Licensing Compliance Workshop Introduction and Presentation Materials
- Exhibit A - Exclusions, Reductions and Limitations for Individual Health Provisions (.pdf format)
- Figures for Mandatory Benefit Notices: 28 TAC § 21.2106
- Notice of Availability of Coverage Under the Texas Health Insurance Risk Pool, §21.2305 Form (.pdf format)
- HIV Consent Form(.pdf format)
- Federal HIPAA Information
- Detailed explanation of the federal and state law which regulate union and ERISA plans
- FAQs About Form Filing Requirements
- Most Common Rejections For Life And Accident & Health Form Filings
- List of Form Filing Fees
- Implementation of the form filing fee billing system, pursuant to 28 TAC §§7.1301 and 7.1302 (effective on February 1, 2005).
- Transmittal Form for Certain Miscellaneous Documents For Life/Health
- NEW - Transmittal Checklist for Life/Health Form Filings
- Summary of Exempt Forms (Download Only, 24K, MS Word, lh_exmpt.zip)
Contact Information and Other Helpful Links
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