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2-50 Eligible Employees
- Small Employer Rate Guide
- Companies Offering Small Employer Coverage
- TexasHealthOptions.com Small Employer Resources
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Workers' Compensation Manual, Rates and Other LinksEmployer Resources for Workers' Compensation Insurance
Workplace Safety Assistance for Texas Employers
51-99 Eligible Employees
- Companies Offering Mid-Size Employer Coverage
- TexasHealthOptions.com Mid-Size Employer Resources
- Healthy Texas Information
100-plus Eligible Employees
- Companies Offering Large Employer Coverage
- TexasHealthOptions.com Large Employer Resources
- Healthy Texas Information
Highlights
TexasHealthOptions.com
- A service of the State of Texas - with links to government & other Web sites to help Texans shop for health insurance.
Lower Health Insurance Cost
- Take a look at Consumer Choice Benefit Plans. A list of HMOs and insurers authorized to offer such plans is available.
Find An HMO
- Look for an HMO in your county or look over HMO profile or report card. HMO financial reports and complaint data too.
Employer Resources - Reporting Requirements for Businesses Not Carrying Workers' Compensation Insurance
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| Reporting Arson | 877-434-7345 |
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| Safety Violations | 800-452-9595 |
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Small Employer Health Benefit Plan Rate Guide
Follow these steps to learn rates for small employer health insurance in your area:
- Visit HealthCare.gov by selecting the link or typing www.HealthCare.gov into your web browser.
- Choose “Texas” from the drop-down menu in the “Explore your coverage and pricing options” box.
- On the next page, choose “Small Employer” from the list.
- On the next page, choose “I need health insurance for my employees.”
- On the next page, choose “Learn More” next to “Private Health Insurance Products for Small Groups.”
- On the next page, enter your ZIP code, the date you want coverage to start, and the number of employees you want to insure.
- On the next page, select “Show me the products.”
- The results screen will list the plans by plan name. Select the plan name to learn what company sells it. You can sort the results by annual out-of-pocket limit, enrollment, and average cost per enrollee.
- Select a plan (or choose up to three to compare plans) to view the plan’s details and pricing.
Other Resources
- Small Employer Health Insurance (TDI publication)
- HealthyTexasOnline.com
- TexasHealthOptions.com
- Federal Health Care Reform Resource Page
For More Information or Assistance
For answers to general insurance questions, for information on filing an insurance-related complaint, or to report suspected insurance fraud, call the Consumer Help Line between 8 a.m. and 5 p.m., Central time, Monday-Friday, or visit our website1-800-252-3439You can also visit HelpInsure.com to help you shop for automobile, homeowners, condo, and renters insurance, and TexasHealthOptions.com to learn more about health care coverage and your options.
463-6515 in Austin
www.tdi.texas.gov
For printed copies of consumer publications, call the 24-hour Publications Order Line
1-800-599-SHOP (7467)To report suspected arson or suspicious activity involving fires, call the State Fire Marshal’s 24-hour Arson Hot Line
305-7211 in Austin
1-877-4FIRE45 (434-7345)
Listing of Companies Licensed to sell Small Employer Accident and Health Coverage in Texas
Note: As of May 2010, these companies are marketing small employer coverage in Texas. However, companies may elect to stop writing new business at any time. Please contact individual companies to learn whether the company currently sells small employer coverage in Texas.
| Company Name | Phone number to call to get a quote |
|---|---|
| Aetna Health, Inc. (HMO) | (866) 899-4379 |
| Aetna Life Insurance Company | (866) 899-4379 |
| American Alternative Insurance Corporation | (800) 305-4954 |
| Best Life and Health Insurance Company | (800) 433-0088 |
| Blue Cross and Blue Shield of Texas | (800) 399-5831 |
| Community First Health Plans, Inc. (HMO) | (800) 434-2347 |
| Connecticut General Life Insurance Company | (713) 552-7600 - Houston office (972) 582-7300 - Dallas office |
| Federated Mutual Insurance Company | (888) 507-0852 |
| Guardian Life Insurance Company of America, The | (800) 356-5808 |
| Humana Health Plan of Texas, Inc. | (512) 338-2532 |
| Humana Insurance Company | (800) 234-7912 |
| Independence American Insurance Company | (212) 355-4141 |
| Insurance Company of Scott and White | (800) 321-7947 |
| John Alden Life Insurance Company (Assurant Health) | (877) 225-5077 |
| Life of America Insurance Company | (800) 876-8776 |
| Madison National Life Insurance Company | (800) 356-9601 |
| Nippon Life Insurance Company of America | (800) 969-5238 |
| Pacificare Life and Health Insurance Company | (800) 458-5653 |
| Republic American Life Insurance Company | (800) 394-0406 (Nexcaliber) |
| Scott and White Health Plan (HMO) | (800) 321-7947 |
| SHA, L.L.C. ( Firstcare HMO) | (800) 884-4901 |
| Southwest Life & Health Insurance Company (Firstcare HMO) | (800) 431-7737 |
| Standard Security Life Insurance Company of New York | (602) 906-6227 |
| Time Insurance Company (Formerly Fortis Benefits) | (800) 800-1212 |
| Trustmark Life Insurance Company (Starmark) | (800) 522-1246 |
| U S Health & Life Insurance Company | (586) 693-4753 |
| Unified Life Insurance Company | (800) 765-4224 |
| Union Security Insurance Company (Formerly Fortis Benefits) | (800) 788-2638 |
| United Healthcare Insurance Company | Contact Local Agent |
| United Healthcare of Texas, Inc. | Contact Local Agent |
| Universal Fidelity Life Insurance Company | (800) 550-8009 |
| Usable Life | (800) 470-9621 |
| Valley Baptist Insurance Company | (877) 422-4400 |
Texas Health Options
Get Help: 1-855-TEX-CHAP (1-855-839-2427)
Health Insurance Information for a Small Business Employer
State and federal law makes a distinction between "small employers" and
"large employers" insurance purposes. Small employers have certain legal
protections, including protections against rate increases, and different rules
regarding the level of coverage a plan must provide. For health coverage
purposes, a business is considered to be a small employer if it has two to 50
full-time employees, defined as employees who customarily work at least 30 hours
per week and are not seasonal or contract workers.
If your business qualifies as a large employer, defined as having more than 50 full-time employees, you should refer to the Large Employer Resource Page. This webpage provides a summary of health coverage options and resources for small employers.
1. Small Employer Health Coverage OverviewIf your business qualifies as a large employer, defined as having more than 50 full-time employees, you should refer to the Large Employer Resource Page. This webpage provides a summary of health coverage options and resources for small employers.
It is a business´ number of eligible employees - not total employees - that determines whether or not it´s considered a small employer under Texas insurance law. For example, if your business has 60 total employees, it could still qualify if six of the workers are part-time and four have coverage through some other source, such as a spouse´s plan.
Small employer coverage must be made available to all
qualifying full-time employees their spouses, and dependents under equal terms
and conditions.
A carrier may require that at least 75 percent of a small employer´s eligible
employees elect for membership as a condition of offering a plan. Carriers must
always "round up" when calculating the percentage. For example, a five-person
business with only three employees wishing to participate satisfies a 75 percent
requirement by rounding up. However, in the case of a business with only two
eligible employees, the law requires 100 percent participation. A husband and
wife working in a business must be counted as two separate employees. The two
employees will not be eligible for coverage as a dependent of one another.A key requirement of small employer status is that coverage must be made available to all qualifying full-time employees and their spouses and dependents under the same terms and conditions, whereas a large employer may exclude spousal and dependent coverage and impose specific eligibility criteria for plan membership. Small employer status also protects the employer by mandating some percentage limitations on annual rate increases. State law also contains many fewer provisions for specific medical conditions that are required to be covered by small employer health plans.
Texas employers may not exclude eligible employees from participation in a health plan based on their age, medical condition, medical history, or other health risk factors.
- For further explanations of the special laws and protections for small employer plans, refer to the TDI publication "Small Employer Health Insurance."
- For price comparisons, refer to the "Small Employer Health Benefit Plan Rate Guide."
2. Indemnity vs. Managed Care
The two primary approaches to health care coverage are typically called known as "indemnity" and "managed care." One of the first decisions that a business providing health coverage will have to make is whether it will offer a plan that is strictly one type or the other, or a plan that incorporates various features of the two.
In general, indemnity coverage offers greater freedom of choice
in obtaining health services but costs more, whereas managed care is more
restrictive but costs less.
Each approach has its trade offs and both have their critics. In general,
indemnity coverage offers greater freedom of choice in obtaining health services
but costs more, whereas managed care is more restrictive but costs less. A
business may elect to offer multiple types of health coverage and allow
employees to decide which best meets their needs. In this situation, typically
the employees who select the more expensive plan pay the difference in
price.Indemnity plans are administered by insurance companies, and are what many people think of as a traditional health insurance. An indemnity health plan will cover the services of any physician, provider or hospital the consumer chooses as long as the care is medically necessary and consistent with the terms of the policy.
Managed care is an alternative approach that has gained popularity within the last two decades as a tool to mitigate rising health care costs. Typically a managed care plan will cost significantly less than an indemnity plan covering comparable conditions and services. A primary way managed care achieves savings by contracting directly with physicians, hospitals and providers to provide services at pre-negotiated rates. A managed care plan can either be administered by an insurance companies or special network of health providers called a "health maintenance organization" (HMO).
Under the strictest form of managed care, which can only be provided by an HMO, members are limited to receiving care only from providers within the HMO network, except under rare circumstances and medical emergencies. Other types of managed care allow members to go outside the network for services, however they must typically pay up to twice as much - or more - out of pocket toward the cost of care than they would pay by remaining within the network.
Approval by a primary care physician is typically required
before an HMO plan will cover any extensive or non-routine medical care, or
consultation with any specialist physician.
HMO managed care plan members are also typically required to select a
"primary care physician" (PCP) as a condition of membership. This doctor becomes
the supervisor of the individual´s medical care and liaison with the other
providers in the network. Approval by the PCP is typically required before the
plan will cover any extensive or non-routine medical care, or consultation with
any specialist physician. Supervising members´ care so that only necessary
health services are provided is another way HMO plans work to control costs.The laws and rules governing HMOs are extensive and in many instances quite complex. For more information, refer to the TDI publication Health Maintenance Organizations.
"Preferred Provider Option" (PPO) plans, which are the managed care plans that are offered by insurance companies, and "Point of Service Option" (POS) plans, which are offered by HMOs, are the two most common ´sub-types´ of health plans that combine the features of managed care and indemnity coverage. Under these plans pre-approval for services from a primary doctor is not required, and care from any provider is covered, although both types of plans are also affiliated with a managed care network that members can opt to use at a substantial discount.
Apart from a few minor differences, as far as plan members are the same PPO and POS plans essentially work in the same way. POS plans are generally somewhat less expensive. The key difference between the plans is in how they are financed internally. In a PPO plan, the insurance company typically pays providers some discount percentage of their normal fee from services. In a POS plan, providers are typically paid a flat fee per patient, regardless of the expense of the care administered.
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3. Coverage Rights and Protections
State and federal law contains numerous protections for both consumers and employer health plan sponsors. Three of the most important are the rights to:
Continuity of coverage. A health carrier may not refuse to renew an employers existing health plan while it continues to offer the plan to other employers in the same market, except for reasons of fraud, nonpayment, or violation of certain health plan terms. However, a carrier may discontinue offering a plan in the market altogether. In this case, the carrier must allow the district to enroll in any other plan it offers in that market. If a company decides to withdraw from the market altogether, it must provide the district and the Commissioner of Insurance 180 days notice before non-renewal of coverage. Carriers that withdraw completely are prohibited from doing business in that market for five years.
State and federal law prohibits employer health plans from
treating pregnancy or genetic information as preexisting conditions.
Portability of coverage. The federal Health Insurance Plan
Portability and Accountability Act (HIPAA) and other laws require health
carriers to provide employees who new plan members with credit toward any
"preexisting condition" waiting period for time the new member spent previously
covered by another creditable health plan during the year prior. A preexisting
condition is defined as any condition for which an individual has received
"medical advice, care or treatment" during the six months prior to joining a
health plan. By law, employee health plan carriers may impose a waiting period
of up to 12 months before extending coverage for such conditions to new members,
even though the conditions are normally covered by the policy. Preexisting
condition rules protect carriers from the possibility of individuals purchasing
health coverage only because they are already sick or ill and know they need
serious treatment.Under HIPAA, If a new health plan member was previously enrolled in another health plan during the year prior, a carrier is required to apply the time spent under the old coverage toward any waiting period of the new coverage on a month by month basis. For example, an individual with no prior coverage who has a pre-existing condition who joins a plan with a 12-month waiting period would have to wait 12-months before any treatment for the condition will be covered. However, had the same individual been previously enrolled in another health plan in the eight months prior to joining the new plan, that time would apply to the new plan´s waiting limit. He or she would therefore only be required to undergo a four month waiting period (12 - 8 = 4). An individual with previous coverage during the full twelve months of the year prior would have no waiting period at all.
HIPAA regulations can be one of the most complex areas of health coverage law. HIPAA.org is a federally administered website created to assist health plan providers with legal compliance.
Preexisting condition limitations. State and federal law prohibits employer health plans from treating pregnancy or genetic information as preexisting conditions. In plans that pay for prenatal care and childbirth, this means these services are covered even if a woman is pregnant when she joins a plan.
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4. Self-funding a Health Plan
Employers with significant financial resources may elect to "self-fund" their employee benefit plan. In effect, the employer becomes its own insurance company, accepting the full financial risk of coverage and paying claims using its own funds.
It is important for a self-funding employer to make certain that it has sufficient resources to pay its employees' health claims to prevent a potential budget shortfall, or even bankruptcy. Self-funding requires an employer to accept many legal responsibilities that would otherwise be handled by the carrier. Employers considering self-funding a health plan should consult legal counsel to be sure they understand the risk and responsibilities involved. Employers who decide to self-fund their health plan may want to consider purchasing Stop-Loss coverage to minimize their financial risk.
Self-funded plans are governed by the federal Employee Retirement Income Security Act (ERISA). Therefore, these plans are often called "ERISA plans." The Employee Benefits Security Administration (EBSA) of the U.S. Department of Labor is the primary regulating agency.
Many self-funding employers contract with "third-party administrators" (TPAs) to administer the day-to-day operations of their health plans. A TPA may either be an insurance company or a separate company that administers self-funded plans exclusively. The TPA manages administrative functions, such as claim processing, collecting employee premiums, and managing enrollment. The TPA assumes no risk of coverage, however. In Texas, TPAs must maintain a valid TPA license to legally operate in the state.
For more information about other options and programs that may be able to help, visit our Resources page.
For more information contact:
ConsumerProtection
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.orgCarriers in the Mid-Size and Large Employer Market
Notice: Inclusion in this list does not guarantee that a
particular company is actively offering this coverage at this time.
This listing was updated on: January 10, 2012 | NAIC Company Number | Company Name |
|---|---|
| 33898 | Aegis Security Insurance Company |
| 95490 | Aetna Health Inc. |
| 60054 | Aetna Life Insurance Company |
| 67369 | Alta Health & Life Insurance Company |
| 60739 | American National Insurance Company |
| 84697 | American Specialty Health Insurance |
| 93688 | Amerihealth Insurance Company |
| 61263 | Bankers Life And Casualty Company |
| 70670 | Blue Cross And Blue Shield Of Texas |
| 95383 | Cigna Healthcare Of Texas, Inc. |
| 20532 | Clarendon National Insurance Company |
| 62146 | Combined Insurance Company Of America |
| 95248 | Community First Health Plans, Inc. |
| 77828 | Companion Life Insurance Company |
| 62308 | Connecticut General Life Insurance Company |
| 63290 | Fidelity Life Association A Legal Reserve Life Insurance Company |
| 68322 | Great-West Life & Annuity Insurance |
| 93440 | HM Life Insurance Company |
| 95024 | Humana Health Plan Of Texas, Inc. |
| 73288 | Humana Insurance Company |
| 11670 | Insurance Company Of Scott And White |
| 81132 | Life Of America Insurance Company |
| 65781 | Madison National Life Insurance Company, Inc |
| 97055 | Mega Life And Health Insurance Company, The |
| 19445 | National Union Fire Insurance Company of Pittsburgh, Pennsylvania |
| 91626 | New England Life Insurance Company |
| 81264 | Nippon Life Insurance Company Of America |
| 70785 | Pacificare Life And Health Insurance Copmpany |
| 95174 | Pacificare Of Texas, Inc. |
| 68381 | Reliance Standard Life Insurance Company |
| 95099 | Scott And White Health Plan |
| 43389 | Service Lloyds Insurance Company |
| 95240 | Seton Health Plan, Inc. |
| 95138 | SHA, L.L.C. |
| 66117 | Southwest Life & Health Insurance Company |
| 69078 | Standard Security Life Insurance Company of New York |
| 71013 | Superior Healthplan Network |
| 10076 | Unicare Health Insurance Company Of Texas |
| 95420 | Unicare Health Plans Of Texas, Inc. |
| 79413 | Unitedhealthcare Insurance Company |
| 95765 | Unitedhealthcare Of Texas, Inc. |
| 97772 | US Health And Life Insurance Company |
| 94358 | Usable Life |
| 12346 | Valley Baptist Insurance Company |
| 16535 | Zurich American Insurance Company |
Texas Health Options
Get Help: 1-855-TEX-CHAP (1-855-839-2427)
Health Insurance Information for a Mid-Size or Large Employer
State and federal law makes a distinction between "small employers" and
"large employers" for insurance purposes. (The term "mid-sized employer" is not
defined by the Texas Insurance Code and is used for practical purposes only. The
same laws and rules that govern large employers also apply to mid-sized
employers.) Mid-sized and large employers are exempted from certain protections
against rate increases and have different responsibilities regarding the level
of coverage a plan must provide. For health coverage purposes, a business is
considered to be a mid-sized or large employer if it has more than 50 full-time
employees, defined as employees who customarily work at least 30 hours per week
and are not seasonal or contract workers.
If your business instead qualifies as a small employer, defined as having between 2 and 50 employees, you should refer to the Texas Small Employer Resource Page.
If your business instead qualifies as a small employer, defined as having between 2 and 50 employees, you should refer to the Texas Small Employer Resource Page.
It is a business' number of eligible employees - not total employees - that determines whether or not it's considered a small employer under Texas insurance law. For example, if your business has 70 total employees, but 30 of them are part-time or contract workers, it would not qualify as a large employer for the purpose of health coverage.
Texas law generally provides mid-sized and large employers with increased flexibility in terms of how a health plan may be offered, and contains fewer requirements for specific coverages that a plan must contain. Most significantly, these employers may only offer coverage as a benefit to certain specific classes of employees, such as employees above a certain pay grade, or who have maintained employment for a certain number of years. An employee's age, prior claims history or any health-related factors may never legally be used as a basis for limiting or denying plan membership, however.
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The two primary approaches to health care coverage are typically called known as "indemnity" and "managed care." One of the first decisions that a business providing health coverage will have to make is whether it will offer a plan that is strictly one type or the other, or a plan that incorporates various features of the two.
In general, indemnity coverage offers greater freedom of choice
in obtaining health services but costs more, whereas managed care is more
restrictive but costs less.
Each approach has its trade offs and both have their critics. In general,
indemnity coverage offers greater freedom of choice in obtaining health services
but costs more, whereas managed care is more restrictive but costs less. A
business may elect to offer multiple types of health coverage and allow
employees to decide which best meets their needs. In this situation, typically
the employees who select the more expensive plan pay the difference in
price.Indemnity plans are administered by insurance companies, and are what many people think of as a traditional health insurance. An indemnity health plan will cover the services of any physician, provider or hospital the consumer chooses as long as the care is medically necessary and consistent with the terms of the policy.
Managed care is an alternative approach that has gained popularity within the last two decades as a tool to mitigate rising health care costs. Typically a managed care plan will cost significantly less than an indemnity plan covering comparable conditions and services. A primary way managed care achieves savings by contracting directly with physicians, hospitals and providers to provide services at pre-negotiated rates. A managed care plan can either be administered by an insurance companies or special network of health providers called a "health maintenance organization" (HMO).
Under the strictest form of managed care, which can only be provided by an HMO, members are limited to receiving care only from providers within the HMO network, except under rare circumstances and medical emergencies. Other types of managed care allow members to go outside the network for services, however they must typically pay up to twice as much - or more - out of pocket toward the cost of care than they would pay by remaining within the network.
Approval by a primary care physician is typically required
before an HMO plan will cover any extensive or non-routine medical care, or
consultation with any specialist physician.
HMO managed care plan members are also typically required to select a
"primary care physician" (PCP) as a condition of membership. This doctor becomes
the supervisor of the individual's medical care and liaison with the other
providers in the network. Approval by the PCP is typically required before the
plan will cover any extensive or non-routine medical care, or consultation with
any specialist physician. Supervising members' care so that only necessary
health services are provided is another way HMO plans work to control costs.The laws and rules governing HMOs are extensive and in many instances quite complex. For more information, refer to the TDI publication Health Maintenance Organizations.
"Preferred Provider Option" (PPO) plans, which are the managed care plans that are offered by insurance companies, and "Point of Service Option" (POS) plans, which are offered by HMOs, are the two most common 'sub-types' of health plans that combine the features of managed care and indemnity coverage. Under these plans pre-approval for services from a primary doctor is not required, and care from any provider is covered, although both types of plans are also affiliated with a managed care network that members can opt to use at a substantial discount.
Apart from a few minor differences, as far as plan members are the same PPO and POS plans essentially work in the same way. POS plans are generally somewhat less expensive. The key difference between the plans is in how they are financed internally. In a PPO plan, the insurance company typically pays providers some discount percentage of their normal fee from services. In a POS plan, providers are typically paid a flat fee per patient, regardless of the expense of the care administered.
Back to Top
Many large employers of businesses with significant financial resources elect to "self-fund" their employee benefit plan. In effect the employer becomes its own insurance company, itself accepting the full financial risk of coverage and paying claims using its own funds. Self-funding can be a way to save money by avoiding the administrative overhead and company profit that are factored into the price of a private sector plan.
Employers considering self funding a health plan should
thoroughly consult legal counsel to be sure they understand the responsibilities
involved.
It is extremely important for a self-funding employer to be certain that it
has sufficient resources to pay health claims that arise, however, or a serious
budget shortfall could result. Self-funding further requires an employer to
accept many legal responsibilities that would otherwise be handled by the
carrier. Employers considering self-funding a health plan should thoroughly
consult legal counsel to be sure they understand the responsibilities
involved.Self-funded plans are primarily regulated according to terms of the federal Employee Retirement Income Security Act (ERISA). The Employee Benefits Security Administration (EBSA) of the US Department of Labor is the primary regulating agency.
Many businesses contract with third-party administrators (TPAs) to administer the day to day operations of the plan. This incurs some additional cost, but it is generally less expensive than purchasing coverage outright. A TPA may either be an insurance company or a separate company that administers self funded plans exclusively. The TPA manages administrative functions such as claim processing, collecting employee premiums and managing enrollment. The TPA assumes no risk of coverage, however. In Texas, TPAs must maintain a valid TPA license to legally operate in the state.
- A list of currently licensed TPAs is available from the TDI website.
State and federal law contains numerous protections for both consumers and employer health plan sponsors. Three of the most important rights include the following:
Continuity of coverage. A health carrier may not refuse to renew an employers existing health plan while it continues to offer the plan to other employers in the same market, except for reasons of fraud, nonpayment, or violation of certain health plan terms. However, a carrier may discontinue offering a plan in the market altogether. In this case, the carrier must allow the employer to enroll in any other plan it offers in that market. If a company decides to withdraw from the market altogether, it must provide the employer and the Commissioner of Insurance 180 days notice before non-renewal of coverage. Carriers that withdraw completely are prohibited from doing business in that market for five years.
State and federal law prohibits employer health plans from
treating pregnancy or genetic information as preexisting conditions.
Portability of coverage. The federal Health Insurance Plan
Portability and Accountability Act (HIPAA) and other laws require carriers to
provide employees who new plan members with credit toward any "preexisting
condition" waiting period for time the new member spent previously covered by
another creditable health plan during the prior year. A pre-existing condition
is defined as any condition for which an individual has received "medical
advice, care or treatment" during the six months prior to joining a health plan.
By law, carriers may impose a waiting period of up to 12 months before extending
coverage for pre-existing conditions to new members, even though the conditions
are normally covered by the policy. Preexisting condition rules protect carriers
from the possibility of individuals purchasing health coverage only because they
are already sick or ill and know they need serious treatment.Under HIPAA, If a new health plan member was previously enrolled in another health plan during the year prior, a carrier is required to apply the time spent under the old coverage toward any waiting period of the new coverage on a month by month basis. For example, an individual with no prior coverage who has a pre-existing condition who joins a plan with a 12-month waiting period would have to wait 12-months before any treatment for the condition will be covered. However, had the same individual been previously enrolled in another health plan in the eight months prior to joining the new plan, that time would apply to the new plan's waiting limit. He or she would therefore only be required to undergo a four month waiting period (12 - 8 = 4). An individual with previous coverage during the full twelve months of the year prior would have no waiting period at all.
HIPAA regulations can be one of the most complex areas of health coverage law. HIPAA.org is a federally administered website created to assist health plan providers with legal compliance.
Pre-existing condition limitations. State and federal law prohibits employer health plans from treating pregnancy or genetic information as pre-existing conditions. In plans that pay for prenatal care and childbirth, this means these services are covered even if a woman is pregnant when she joins a plan.
For more information about other options and programs that may be able to help, visit our Resources page.
Back to Top
For more information contact:
ConsumerProtection
directly from the texas department of insurance website
www.nationwide.com/joshlewis
www.austinhealthbrokers.com
Workers' Compensation Classifications
Research | Statistical Plan | Workers' Comp Coverage | Workers' Comp Manual DownloadsWorkers' Compensation Research
- Workers Comp Research Group - Reports and Research Material
- ROC 2003 Annual Report to the Governor and Legislature | and the Word Version
- ROC and Other Workers Comp Reports / Studies
Statistical Plan
- DCI Stat Plan - 1997 - Workers' Comp (296K, PDF)
- DCI Stat Plan - 2010 - Workers' Comp (387K, PDF)
- Texas Unit Statistical Plan and Reporting Instructions (Download Only, 159K, MS Word , unitstat.zip)
Workers' Compensation Coverage
- Texas Workers' Compensation Rate Guide
- Texas Basic Manual of Rules, Classifications and Experience Rating Plan for Workers' Compensation and Employers' Liability Insurance (MS Word, wcmanual.zip OR PDF, wcmanual.pdf) OR Pick a specific section to download
- Resources for Small Businesses
- Shopping for Workers' Comp Insurance
Subscribe
Subscribe to Property & Casualty Bulletins via eNews.For workers' compensation claims information, contact: WorkersCompCustomerServices
For coverage information, contact: WorkersComp@tdi.state.tx.us
Texas Workers' Compensation Manual
Updated: June 15, 2011- wcrules.zip or wcrules.pdf - manual rules and rules index for Workers' Compensation
- 99alpha.zip or 99alpha.pdf - alphabetic listing of workers’ compensation classifications.
- 99numeric.zip or 99numeric.pdf - numeric listing of workers’ compensation classifications.
- erplan.zip or erplan.pdf - workers’ compensation experience rating plan.
- endform.zip or endform.pdf - workers’ compensation endorsements and forms.
Texas WC Retrospective Rating Plan Manual (6,141KB, PDF)
Requesting P&C Filings / Information
Highlights
Research
- Workers' Compensation Research & Evaluation is responsible for conducting studies and research on workers' compensation issues
Networks
- Health & Workers' Compensation Network Certification and Quality Assurance is to regulate HMO's and certify and regulate Certified Workers' Compensation Networks.
Classifications
- Division of Workers' Compensation provides a variety of services to employees and employers, including information assistance, self-insurance certification, education and training services, dispute resolution services, accident prevention services, and enforcement/compliance services.
Shopping for Workers' Compensation
Insurance | Office of Injured Employee Counsel | Workplace Safety |
Self-Insurance
Regulation
Reporting a Workplace Safety Violation | Health Care Networks for Injured Employees | Complaint Resolution form
| Help For | Toll-Free # |
|---|---|
| Injured Employees | 800-252-7031 |
| DD Scheduling | 512-804-4380 |
| EDI Help Desk | 888-4TXCOMP |
| MFDR | 512-804-4812 |
| Safety Hotline | 800-452-9595 |
| [ tdi phone listings ] | |
| Help For | Link |
|---|---|
| Fraud | |
| General Information | |
| Safety Tools | |
| Open Records | |
| Website | |
| Favorite Links | |
|---|---|
| Attorney Fees | Publications |
| Find a Doctor | Rules |
| Forms | TXCOMP |
| Verify Network Coverage | Verify Employer Coverage |
| [ popular links · more lookups ] | |
For more information contact: WorkersComp@tdi.state.tx.us
Last updated: 09/24/2012
