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www.txhealthpool.org

Health Pool Premium Rate Information       
 

Click Here for Regular Rate Tables Effective 08/01/2012

Click Here for Medicare-Disabled Rate Tables Effective 08/01/2012

               Yes, the Texas Legislature created a premium subsidy program to assist lower-income Pool enrollees whose household incomes
               are at or below 300% of the federal poverty level (FPL). 

               Click Here to view the Pool's premium subsidy application form to determine whether you may qualify for a subsidy. 

               If your annual household income, as defined by the Pool, falls below the limits shown on the application form for your household
               size, you will be eligible for a premium rate that is lower than the amounts shown in the Pool's Premium Rate Tables.  Household
               income below 200% of the FPL qualifies for a 50% premium reduction; and household income between 200% and 300% of FPL
               qualifies for a 30% reduction.  Refer to the chart below for subsidies associated with household income.  A household consists of all
               related family members living in the same residence, or who consider that residence to be their permanent address, regardless of
               dependency status.   

                    Once you are enrolled in the Pool and have received your Policy and Member ID Card you will receive a premium subsidy
                    application form and instructions in the mail. 

                    Call the Premium Subsidy Department at 888.538.9853 or 512.441.7665 if you need more information about the subsidy
                    program.

• How are the Pool's premium rates determined?

The rules that establish how the Pool's premium rates are determined are set out in Chapter 1506 of the Texas Insurance Code.  This statute requires that the Pool determine appropriate rates through a review of the average rates charged by major Texas health insurers for individual health coverage.  This average rate is called the "Standard Risk Rate" and the Pool's actuary periodically updates this Rate in order to reflect changes in the market, often referred to as "trend".  As a result, the Pool's rates will increase when market rates go up.  In addition to periodic trend rate increases, premium rates paid by  members will also increase when the member moves up to the next age band, moves to a different zip code rating area, or changes tobacco use status.

•  How high above the standard rate must the Pool's rates be set?

State law requires the Pool to set rates to fully cover all costs, but not to exceed twice the Standard Risk Rate.  

• Are there any other factors that impact the Pool's rates? 

In addition to the trend adjustments to rates, the Pool is also required to make periodic adjustments to the premium rate table to reflect changes related to certain rating categories, including deductible plan, gender, age, tobacco-user status, and geographic location to more appropriately relate the Pool's rates to the Standard Risk Rate and to reflect the Pool's actual claims experience.

• What can I do to reduce my premiums?

                   You are allowed to change your deductible plan to a higher deductible once each year.  It may be to your
                   advantage to increase your deductible plan, but you need to carefully review the lower premium and
                   compare the savings to the increased deductible associated with a higher deductible plan, and
                   the higher coinsurance and higher prescription deductible associated with the $7,500 plan. 

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If you have any questions concerning the Pool's premium rates, please contact the Pool's Administrator at 1-888-398-3927.