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Qualifying for Texas Individual Health Insurance

Important Update:  With Health Reform Changes Effective Jan 2014, Medical Underwriting is Not Required for Most Plans.  Contact Us regarding your situation.  The information below may apply to Short term and non-ACA plans.

Individual and Family insurance is different from Group (Company) insurance in that they can decline and or change rates based on your health at the time of application. Below we have some common reasons for difficulties in getting approved but first a few quick tips regarding qualifying for coverage.

Some situations require time away from the condition in order to qualify. For simple situations, a 6 month period sign, symptom, and treatment free is a good estimate. This can also pertain to medication.  

It is not uncommon to be declined by one carrier and accepted by another even though the carriers have very similar underwriting requirements.

If we are declined by a carrier, we lose our Short Term option. If there is an issue, and you have no coverage, we recommend getting Short Term coverage first and then apply for the permanent plan. Get more info here.

Brand name medication are heavily scrutinized these days due to the cost associated with their use.  

If you are currently on Cobra, it typically makes sense to apply for coverage as there is no down side. You can remain on your Cobra if the coverage is not approved. Cobra is usually quite expensive.

The carriers can offer a split approval where one member is not approved but the rest of the family is. The carriers are mainly looking at current/recent and ongoing situations. We all have a medical history but situations that are stable, from which time has passed, typically do not cause problems.

If you are exhausting or losing Cobra (continuation of group coverage) you may be eligible for HIPAA. Please check with us if this sounds applicable.

Some common reasons for declination/deferrals of coverage:

  1. currently pregnant or an expecting father
  2. multiple medications especially brand name
  3. recent (last 6 months including physical therapy) injury
  4. recent (last 2-3 years) treatment for heart disease, diabetes, cancer, immune system disorders, or any other serious medical condition
  5. height/weight outside guideline range
  6. multiple conditions/injuries/illnesses

If you have questions about your preexisting conditions whether listed above or not, please call us at 866/444-3332 or email us to receive personal assistance from a licensed agent. We will be able to advise you based on your specific medical history.
Of course, if you have questions, please contact us. That's what we are here for.
Toll Free: (866) 444-3332
Austin Local: (512) 542-9760
Toll Free Fax: (800) 349-2730

You can run your Texas Health Plan Quote here to view rates and plans side by side from the major carriers...Free.

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