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individual health insurance plans in texas
A single master policy is issued to an individual or entity representing the group of people. As we stated, for our purposes we will call this the employer. It is the employers responsibility to apply for coverage for the group, own and hold the master policy and collect and make premium payments to the insurer when due.
Health insurance is generally available through groups and to individuals. Premiums—the regular fees that you pay for health insurance coverage—are generally lower for group coverage. When you receive group insurance at work, the premium usually is paid through your employer.
A reciprocal company is based on the model of give and take. Members agree to share insurance responsibilities among all members. All members insure one another and share in the losses and no member can buy insurance without committing to providing insurance in return. This type of consumer cooperative is managed by an attorney-in-fact who handles all matters of business for the cooperative.
Hospital expense is another type of potential group coverage. These policies can pay for hospital expenses whether inpatient or outpatient. Fees of an attending physician during hospital treatment may be covered. Some types of group policies may only cover surgical expenses.
We discussed earlier that not all members of a group are necessarily eligible under a group plan. Also, the employer may set certain eligibility requirements. Often working couples both qualify for group health insurance through their employment whereby the spouse is covered by each plan. To prevent possible abuse, special provisions are required by law in most states. This is referred to as a Coordination of Benefits Provision and allows insureds as much coverage as possible while doing away with over insurance. Receiving dual benefits constitutes fraud and is punishable by law.
Additionally, there are two types of consumer cooperatives. One is the mutual insurance model discussed previously and the other less common and unincorporated type is a reciprocal company.
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