How to Make Changes to Self-Funded Health Insurance in Texas

Making changes to your self-insured health plan is very different from making changes to other types of health insurance. Self-insured health insurance is a dynamic type of insurance. Unlike other types of health insurance, it does not deal with enrollment periods. Rather, the plan’s flexibility allows the beneficiaries to make changes depending on the company and its employees’ needs and desires.

One of the advantages of self-insured health insurance plans is that they are flexible. Consequently, the company offering its employees a self-insured plan creates the plan based on the needs and desires of its employees. In the same vein, they have a nearly unlimited ability to make changes to coverages, add or remove benefits, change the balance of copays and deductibles, and so on based on the needs and desires of their employees. Usually, these changes are either made to the company directly, or the plan’s administrator, possibly through an employee benefits advisory committee.

You can speak to your plan’s administrator or a Texas-licensed insurance agent to know more about making changes to self-insured health insurance.

Can I Make Changes to the Coverage of My Self-Insured Health Insurance Policy?

Yes, you can make changes to your self-insured health policy. Your plan determines the types and levels of changes you can make to your policy.

What Can Be Changed in a Self-Insured Health Insurance Policy in Texas?

It varies depending on the self-funded health insurance your employer is offering. There is no fixed list of things that can be changed in a self-insured health insurance plan. You can ask for a change with your coverage benefits and cost-share. Changes regarding coverage benefits are mostly made to take effect in the following year. In the same vein, changes that relate to the share of cost may take effect the following year or, in emergencies, at any time to enable you to pay your health coverage conveniently. It could be about your monthly premiums, deductible, copay, co-insurance, or your maximum annual out-of-pocket amount.

You may speak to an insurance agent licensed in Texas to know how these changes will affect you.

Also, you can report changes relating to any of the following:

• Annual income estimate
• Health coverage availability
• Household composition
• Correction of erroneous information
• Update of a federal or state-recognized status

You should promptly report changes to your estimated annual household income to ensure that your premiums and health coverage are affordable according to federal requirements. An employer must ensure that its employee’s coverage policy costs less than 9.61% of their 2022 household income. There are penalties for employers that fail to comply.

You should report health coverage availability changes, such as if you or a member of your household gets or qualifies for:

• an employer-sponsored plan; or
• coverage from a government health program such Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP); or
• loses coverage, such as job-based coverage or Medicaid.

You should report changes to your household or its members, such as:

• Childbirth
• Adoption of a child
• Putting a child up for adoption or foster care
• Becoming pregnant
• Getting married or divorced
• A child in your household turning 26 years old
• Death
• Gaining or losing a dependent in another way
• Changing a permanent address in Texas.

Report changes relating to mistakes or erroneous information regarding your name, date of birth, or Social Security number or of any one of your household members. You could also provide or change your emergency contact list.

Report status changes like:

• Disability status
• Tax filing status
• Citizenship or immigration status.

Generally, you should contact your plan administrator or employer to know what you can change in your self-insured plan.

How Can I Make Changes to an Active Self-Insured Health Insurance Policy?

An employee can make changes by contacting the Human Resources Employee Benefits Department of your employer. If your employer puts a plan administrator in charge, you can make changes by contacting the plan administrator. The most common mode of communication is by email or through the employee benefits online portal, where the employee can request changes for coverage and to communicate with the administrator.

An employer can:

• Make changes to the structure of how a self-insured plan is funded by themself, or with the help of a third party administrator (TPA).
• make changes to the active self-insured plan of an employee only with the employee’s consent.

Can I Change the Coverage Amount After Paying for a Self-Insured Health Insurance Policy?

Changing your coverage amount after paying for your self-insured health insurance is possible. However, your plan may restrict the times you can make such changes. Some plans limit such changes to the end of the year, to take effect in the following year.

Can I Add People to Self-Insured Health Insurance?

Yes, you can add members of your household to your self-funded health insurance plan if your plan allows it. You should contact your plan administrator or your company’s Human Resources representative during the authorized period.

Always talk to an insurance professional about the changes you want to make. The addition of a new covered individual may substantially impact your overall plan needs and costs. An insurance agent can tell you if your existing health insurance plan can be tweaked or if you would be better off with a completely different plan.

If your current plan does not permit you to add new household members, your family members can purchase new health coverage independently.

Can I Remove People from Self-Insured Health Insurance?

Yes. You can remove people from your self-insured health plan. You can remove a deceased member or your child who is over 26 years old. To remove a member of your household, discuss with your plan administrator or your employer’s Human Resources representative.

What Can Be Changed in Self-Insured Health Insurance Without Your Consent?

Nothing can be changed in your self-insured health plan without your consent.