Texas Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Texas Health Insurance Risk Pool / THIRP

Insurance Regulation Establishing Risk Pool
Texas Legislation
Senate Bill 467

Funding

The Texas Health Insurance Risk Pool is fund through assessments on insurance carriers with no tax offset and also through the premiums that are collected from enrolled plan members.

Plans Offered

There are three medical insurance plans offered through THIRP. All are PPO plans with a variable of three different deductibles.

Plan Benefits

The THIRP PPO Plan offers a range of In-Network deductibles, including a $1,000, $2,500 and $5,000 deductible. For most in-patient covered medical expenses, the THIRP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the THIRP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit, which includes deductible, is $4,000 on the $1,000 deductible plan, $5,500 on the $2,500 deductible plan, and $8,000 on the $5,000 deductible plan.

THIRP Plan Brochure

Maximum Benefit Limits

The THIRP PPO Plan offers a range of In-Network deductibles, including a $1,000, $2,500 and $5,000 deductible. For most in-patient covered medical expenses, the THIRP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the THIRP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit, which includes deductible, is $4,000 on the $1,000 deductible plan, $5,500 on the $2,500 deductible plan, and $8,000 on the $5,000 deductible plan.

Eligibility

• You are under age 65 and a resident of Texas and you are able provide evidence that you have maintained health continuous health insurance coverage for the 18 months immediately preceding your application. You may not have a gap in coverage of more than 63 days and your last health insurance coverage was through an employer sponsored plan, church plan, government plan or another state's high risk pool
• You are under the age of 65 you are certified as eligible under Trade Adjustment Assistance of the Pension Benefit Guaranty Corporation
• You are under age 65, a U.S. citizen and a resident of Texas, or a permanent legal alien status with at least three continuous years in the U.S. and can provide evidence of one of the following: 1) A notice of rejection or refusal for individual health insurance for medical reasons from another health insurance, or 2) a certification from an agent that states you will not be able to obtain health insurance because you will be declined for coverage due to a pre-existing medical condition according to the underwriting guidelines of the insurance company, or 3) you were offered individual medical insurance through another insurance company, but with exclusion riders for pre-existing medical conditions, or 4) you have been diagnosed with one of the medical conditions determined as a condition for automatic eligibility by the risk pool
• You do not have other health insurance in effect on the date your coverage with the risk pool would become effective
• You are not eligible for group health insurance or a self-insured health benefit plan, including eligibility for COBRA continuation coverage, except 1) coverage, continued under state or federal law that was maintained for the period of time required to meet the preexisting condition limitation period for under the risk pool, 2) an group health plan, church plan or government plan coverage placed exclusions or limitations on the policy due to pre-existing medical condition
• You must have exhausted all COBRA if they were made available to you
• Other restrictions that apply to previous coverage may apply

Enrollment Periods

You may apply for coverage under THIRP at anytime. Once approved, your coverage will become effective on the first day of the following month.

Premium Payments

Premiums are based on age, gender, zip code and history of tobacco use.

Premium Calculations

The current premium calculations are set at 200% of the standard risk rate provided by individual health insurance companies offering similar type coverage to eligible individuals in the state of Texas.

Pre-Existing Condition Waiting Periods

There is a 12 month waiting period for receiving benefits on pre-existing medical conditions, unless you qualify for a waiver. A waiver is granted to an individual who has had 12 months of creditable coverage that terminated no more than 63 days before the effective date of coverage under the risk pool.

Texas Health Insurance Risk Pool Contact Information

Texas Health Insurance Risk Pool
P. O. Box 6089
Abilene, Texas 79608
(888) 398-3927

THIRP Website

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