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Texas Health Insurance Pool Insurance Claim

Filing The Claim with Texas Health Insurance Pool Provider

You can file a claim with Texas Health Insurance Pool using the paper claim form located at http://txhealthpool.com/Claim_Form_REV_08-09.pdf. Alternatively, if you are covered by MedCo Health Solutions for prescription medications you can submit your claim using the prescription claim form at http://txhealthpool.com/MedcoClaimFormRev8-2009.pdf.

Texas Health Insurance Pool was created by the government of Texas to help residents gain health insurance coverage when deemed uninsurable by individual insurance companies. With the passing of the Affordable Care Act and subsequent insurance marketplace system setup at HealthCare.gov, the Texas Health Insurance Pool will stop taking applications as of January 1, 2014. Residents of Texas will apply for coverage after January 1, 2014 via the HealthCare.gov website.

About a Texas Health Insurance Pool Plan

Premium rates for Texas Health Insurance Pool are set by income. If you earn more than 300% of the federal poverty income standards are required to pay full premium for coverage. Income falling between 200% and 300% of federal poverty income standards is eligible for a 30% discount. Income below 200% of federal poverty income standards is eligible for a 50% reduction in premiums.

Coverage Details

Texas Health Insurance Pool offers five health insurance plans to residents of the state of Texas. Complete details about what is covered, insurance maximums and other medical details are available at http://txhealthpool.com/benefits.html.

  • Plan I: $1,000 deductible per year. In-network co-insurance at 20% and out-of-network co-insurance of 40%. Co-insurance maximum of $3,000.
  • Plan II: $2,500 deductible per year. In-network co-insurance of 20% and out-of-network co-insurance of 40%. Co-insurance maximum of $3,000.
  • Plan III: $5,000 deductible per year. In-network co-insurance of 20% and out-of-network co-insurance of 40%. Co-insurance maximum of $3,000.
  • Plan IV: $7,500 deductible per year. In-network co-insurance of 20% and out-of-network co-insurance of 40%. Co-insurance maximum of $5,000.
  • Plan V: $3,000 deductible per year. In-network co-insurance of 0% and out-of-network co-insurance of 40%. Co-insurance maximum of $0.

Where to Get a Quote: Texas Health Insurance Pool Contact Info & Login

By phone (customer service/claims): 1-888-398-3927

By phone (customer service/claims fax): 1-325-793-4134

By phone (customer service/claims TDD): 1-800-735-2989

By phone (pharmacy customer service/claims): 1-800-290-1708

By phone (chronic disease management): 1-800-432-8421

By phone (pool management): 1-512-441-7665

By phone (pool management fax): 1-512-441-7690

By email (customer service/claims): texashealthpool@bcbstx.com

By email (pharmacy customer service/claims): poolinfo@txhealthpool.org

By email (chronic disease management): diseasemanagement@urmedwatch.com

By email (pool management): browning@txhealthpool.org

By mail (customer service/claims):

Texas Health Insurance Pool P.O. Box 6089 Abilene, TX 79608

By mail: (pharmacy customer service/claims):

MedCo Health Solutions 100 Parsons Pond Dr. Franklin Lakes, NJ 07417

By mail (chronic disease management):

MedCo 120 International Pkwy Ste. 220 Lake Mary, FL 32746

By mail (pool management):

Texas Health Insurance Pool 1701 Directors Blvd. Ste. 120 Austin, TX 78744

Official website: http://txhealthpool.com

Inquire about your Texas Health Insurance Pool claim status: Once your claim is filed you can check your Texas Health Insurance Pool claim status by calling 1-888-398-3927.

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