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Texas Health Insurance Pool
1-888-398-3927
TDD 1-800-735-2989

 
www.txhealthpool.org

texashealthpool@bcbstx.com
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        About the Pool

 

Health Pool Premium Rate Information       
 

 
[Click Here] for Premium Rating Areas by County Effective March 1, 2014
[Click Here] for Regular Rate Tables Effective March 1, 2014
[Click Here] for Medicare-Disabled Rate Tables Effective March 1, 2014
 
  • IMPORTANT NOTICE: The Pool will discontinue all automatic bank drafts at the end of December, and will start mailing premium invoices to Pool policyholders for the extended coverage period from January 1, 2014 to March 31, 2014, when all Pool coverage ends.  You must continue to pay your Pool premiums during this extension period in order for your Pool coverage to remain in force.  If you have lined up replacement coverage with an insurer, and no longer need your Pool coverage after December 31, 2013, please send us a written coverage cancellation request, using this form.  You may also send a cancellation request by email to: texashealthpool@bcbstx.com

  • 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 change 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.

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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.