Understanding Healthcare sometime feels like slogging through a rainforest. There are vines, tree limbs and a variety of creatures. As a purchaser of health insurance, here are some of your rights:

Companies can’t put dollar limits on your care.

Insurance companies cannot limit the dollar amount paid out for your healthcare. Instead, there is often a maximum out of pocket limit for what YOU might pay for your healthcare.

Your policy can’t be rescinded.

Insurance companies can’t rescind your policy if you unintentionally made a mistake on your application for insurance. Companies may rescind a policy only if you commit fraud or lied on your application. Rescind means to cancel a policy back to the start date as if you’d never had coverage.

Coverage renewals are guaranteed.

Most individual health plans are guaranteed renewable. This means your insurance company can't cancel your policy due to age or health (until you are Medicare eligible).

Plans must have adequate networks.

Texas law requires HMOs, PPOs, and EPOs to make covered services available within a certain distance of your home or office. Health plans also must:

• Have enough providers to meet the needs of their members.

• Let you keep going to your doctor for a period of time after your doctor leaves the network. To do this, you must have a terminal illness, disability, life-threatening condition, or be pregnant. The doctor must agree to continue treating you at the plan’s contract rate.

• Pay for care to stabilize your condition after an emergency. If you get emergency care at a facility outside your network, you may be transferred to a network hospital when your condition is stable.

• Pay for care outside your network if you need care that’s not available in the network.

Employers must have an open enrollment period each year. If your employer offers a health plan, the employer must have a 31-day open enrollment period each year. You can use this period to join the plan if you didn’t earlier. You can also use it to drop or change your coverage.

Knowing your rights can save you time and money on health insurance costs. Talk with a Licensed Health Insurance Agent to find out more about your rights and options.

Adapted from an article by Texas Department of Insurance

This article is for information only and should not be considered a recommendation. Talk with a licensed Health Insurance Professional about your specific circumstances. For more information you can go to The Texas Department of Insurance.