As of August 2007, the state reports that there were 370,000 agents, agencies and insurance adjusters licensed by the state. All agents who sell insurance within the state of Texas must have their license reviewed and approved by the state’s licensing division. Effective November 9, 2007, agents who have a temporary license are prohibited from selling Medicare Advantage health or prescription drug plans.
Agents can apply for their license online at the department’s website. It is mandatory that agents extend their education and receive at least 30 credit hours of continuing education over a course of two years. Only five hours of the education can be self-study. A list of certified course providers are available by state on the department’s website.
Workers’ Compensation
Healthcare provider networks that offer care to injured workers are required to be certified by the Texas Department of Insurance. Employers who participate in the state’s Workers’ Compensation Network (WCN) must notify all employees of their rights within the program.
Newly hired employees are required to be notified within three days of employment. Unless it is an emergency, employees in the program must receive workers’ compensation related medical care from physicians in the network.
Medical Malpractice Insurance and Prescription Drugs
State mandates require nursing homes to have medical malpractice insurance. The Texas Department of Insurance reviews insurance polices offered by licensed insurers. The department also regulates malpractice insurance rates throughout the state.
Insurers must provide clients with a 90 day minimum notice after they decide not to renew a policy. Should a malpractice insurance provider become insolvent, physicians and healthcare facilities will receive coverage and protection through the Guaranty Fund.
Healthcare insurance providers that offer prescription drug benefits coverage must allow all eligible insured persons to have access to the same physical or mental health prescription drugs. Prescription drugs must be approved by the Food and Drug Administration (FDA) and proven to treat the specific illness that the prescription is for.
Health Maintenance Organization (HMO)
HMOs are required to allow women insurance program participants to select an Obstetrics and Gynecology (OBGYN) in addition to having a primary care physician. HMO plan participants who have a chronic illness are eligible to be approved by their plan’s HMO medical director to use a non-primary care specialist as their primary physician. For example, a plan participant who has a chronic heart condition can request approval from the medical director to use their cardiac specialist as their primary physician.
Long term insurance care is provided under Texas health insurance regulations. Agents are required to be licensed before they can sell insurance within the state. To validate that residents receive adequate coverage, employers must notify employees of their worker’s compensation programs and nursing homes are required to have medical malpractice insurance. HMOs must provide specific care to women and residents who have chronic illnesses through primary and specialist physicians. Residents of the state who need long term care can work through their health insurance provider to gain assistance or they can call the state’s consumer help line at 1-800-252-3439. The service is open Monday through Friday from 8:00 a.m. until 5:00 p.m.
Sources:
Texas Department of Insurance. 26 July 2009.
 |
