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Texas Department of Insurance
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Health insurance: 5 things you may not know

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Traditional health insurance, the kind you get through your employer or buy on Healthcare.gov, covers a wide range of services if you get sick or hurt. This is called major medical or comprehensive health insurance. Here are five things to know about a major medical plan:

man in hospital bed talking to doctor
  1. Preexisting conditions

    Health insurance companies cannot deny you coverage or charge you more because of an existing health condition or disability. When deciding how much to charge you, companies can only use your age, where you live, whether you smoke or use tobacco, and whether the coverage you're buying is for an individual or a family.

  2. Children included

    Children may stay on their parents' plans until age 26. They don't have to live at home, be enrolled in school, or be claimed as a dependent on their parents’ tax return. Children with disabilities may continue to get coverage after age 26. And Texas law requires insurers to provide coverage for dependent grandchildren up to age 25.

  3. How to appeal

    Most plans have a process to appeal if a claim is denied. If you appealed with your health plan, and you're not satisfied, you may be able to request an external review by an independent group. To learn more about that process, visit the Federal External Review Process website.

  4. No dollar limits

    Insurance companies cannot put dollar limits on the amount they will pay for the covered health care you receive in a year or over your lifetime.

  5. Filing a complaint

    TDI regulates individual and some employer health insurance and can help you with complaints about those plans. If your health plan ID card has “TDI” or “DOI” on it (see examples), you can file a complaint with us. Learn more about how to file a complaint or call 800-252-3439 for help.

If you want to find more information about other types of health coverage visit the Health care coverage guide.

 

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For more information, contact: MediaRelations@tdi.texas.gov

Last updated: 12/8/2022