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Employer xclld insurance; denied by risk pool
Sep 23, 2002

We live in Texas, and I am beginning to think we have no options left. My husband's employer cancelled the insurance (only 20 employees, so no COBRA available), but to offset the cost of getting individual insurance, they are giving everyone 200 employee only/400 employee and family in pre-tax money. Well, I tried the HIPAA route for an individual policy and was told that TX has a risk pool, so there is no individual HIPAA policy available. So we applied with the risk pool, but we were denied because the employer is giving everyone pre-tax money, which creates a small group. This leaves my husband without insurance. Is there anything else out there, or am I going to have to get a job? (Which has been unsuccessful so far finding one with benefits!) Please help! We are 19 days into our 63 without coverage! (By the way, my husband is HIV positive, but does not have AIDS)

Response from Ms. Franzoi

I am not familiar with Texas law but it does surpise me that insurance companies in Texas don't have to offer a HIPAA policy if they have a risk pool. I am basing this on my understanding of state requirements and that is that a state must implement: (1)a law that follows either the NAIC Small Employer and Individual Health Insurance Availability Model Act or the Individual Health Insurance Portability Model Act - both adopted by NAIC on June 3,1996; and (2) a qualfied high risk pool; or (3) an alternate availability mechanism. I suggest that you contact a legl aid organization to find out what the law is in Texas and what your rights are. Your only other option would be to find a job in which you are offered benefits, including medical coverage for you and your dependents.



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