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TEXAS HEALTH INSURANCE RISK POOL
SUMMARY OF COVERAGE
(PART 3)
By Patricia Barrett, CFP CDFA Mediator
EXCLUSIONS & PREMIUMS:
While there is a long list of typical exclusions and limitations, of particular interest are the following exclusion that are not covered:
1) Intentionally self-inflicted injury or illness or attempted suicide, while sane or insane.
2) Overdose of drugs, narcotics or other substances, unless administered on the advice of a physician.
3) Charges for experimental treatments or services.
4) Any penalty or fee for the failure to keep a scheduled visit with a physician.
5) Any service that is not medically necessary.
6) Injury due to the insured person’s being under the influence of intoxicants.
The following tables provide the premium rates for Houston and surrounding counties for a non-smoker. Note that the premiums vary by the amount of the deductible and the age of the party. Find your section by the first three digits of your zip code and your age:
Area 5 Includes zip Codes beginning with 773, 774 and 775
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Area 5
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Plan I, $1,000 Deductible
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Plan II, $2,500 Deductible
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Plan III, $5000 Deductible
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Plan IV, $,7500 Deductible
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Age
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Male
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Female
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Male
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Female
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Male
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Female
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Male
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Female
|
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0-18
|
400
|
400
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298
|
298
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234
|
234
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206
|
206
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19-24
|
432
|
574
|
328
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433
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249
|
333
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218
|
293
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25-29
|
453
|
630
|
337
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470
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261
|
365
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229
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322
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30-34
|
512
|
691
|
382
|
514
|
297
|
401
|
262
|
353
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35-39
|
580
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748
|
433
|
562
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334
|
434
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294
|
382
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40-44
|
669
|
821
|
501
|
612
|
387
|
477
|
339
|
420
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45-49
|
780
|
883
|
582
|
661
|
452
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513
|
397
|
451
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50-54
|
919
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972
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685
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728
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534
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563
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470
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496
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55-59
|
1165
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1068
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870
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794
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676
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620
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595
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545
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60-64
|
1333
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1265
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997
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943
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771
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733
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678
|
646
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Area 6 includes zip codes beginning with 752, 753, 770, and 772:
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Area 6
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Plan I, $1,000 Deductible
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Plan II, $2,500 Deductible
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Plan III, $5,000 Deductible
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Plan IV, $7,500 Deductible
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Age
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Male
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Femane
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Male
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Female
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Male
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Female
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Male
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Female
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0-18
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431
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431
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321
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321
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249
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249
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218
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218
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19-24
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468
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620
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352
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469
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270
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361
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238
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318
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25-29
|
486
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678
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362
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504
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280
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389
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246
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341
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30-34
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550
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746
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413
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553
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321
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433
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282
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381
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35-39
|
624
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805
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469
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600
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361
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466
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318
|
411
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40-44
|
723
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881
|
539
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662
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419
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513
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368
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451
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45-49
|
835
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955
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629
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712
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484
|
552
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425
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486
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50-54
|
992
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1051
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741
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785
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578
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611
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509
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537
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55-59
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1259
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1148
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939
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856
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730
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667
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644
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587
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60-64
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1439
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1360
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1077
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1017
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837
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789
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736
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694
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For more information, see Summary of Coverage and Policy Deductibles and Benefits.
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