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Health insurance: 5 things you may not know

Health insurance helps you get and pay for the care you need if you get sick or hurt. Here are five tips to make the most of your qualified health plan coverage.
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1 Preexisting conditions

Health insurance companies cannot deny you coverage or charge you more because of a health condition or disability. When deciding your premium, companies may consider only your age, where you live, whether you smoke or use tobacco, and whether the coverage you're buying is for an individual or a family. They may not consider any medical condition or history, disability, or other health factors.

2 Children included

Children may stay on their parents' plans until age 26. They don't have to live at home, be enrolled in school, or be claimed as a dependent on their parents’ tax return. Children with disabilities may continue to get coverage after age 26. And Texas law requires insurers to provide coverage for dependent grandchildren up to age 25.

3 How to appeal

Most plans have a process for you to appeal if a claim is denied. If you appealed with your health plan, and you're still not satisfied, you may be able to have an independent review organization (IRO) consider the denial. An IRO is an independent third party certified by TDI. The insurance company or HMO must pay for the review, and it must follow the IRO's decision.

4 No dollar limits

Insurance companies cannot put dollar limits on the amount they will pay for the covered health care you receive in a year or over your lifetime.

5 Filing a complaint

TDI regulates fully funded health plans and can help you resolve complaints with those plans. If your health plan ID card has “TDI” or “DOI” on it, you can file a complaint with us. Use our online resource for more information about to file a complaint or call 1-800-252-3439 for information.


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Last updated: 3/2/2018