Key Takeaways
- Texas requires a 10-day free look period for individual health insurance policies
- Texas small group health plans must cover preexisting conditions after 12-month waiting period
- Texas requires coverage of certain mandated benefits including diabetes supplies and mammograms
- Health insurance policies must include a 31-day grace period for premium payment
- Texas operates a federally-facilitated health insurance marketplace
Last updated: January 2026
Texas Health Insurance Policy Requirements
Texas has specific health insurance regulations that protect consumers and ensure adequate coverage.
Free Look Period
Texas provides a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- No questions asked, no penalty
- Applies to individual health policies
Grace Period
Texas requires a 31-day grace period for premium payment:
| Grace Period Type | Duration |
|---|---|
| Annual premium policies | 31 days |
| Monthly premium policies | 31 days |
| Weekly premium policies | 10 days |
During the grace period:
- Coverage remains in effect
- Policyholder can pay without penalty
- Insurer cannot cancel for nonpayment during grace period
Preexisting Condition Rules
Small Group Plans (2-50 employees)
- 12-month waiting period maximum for preexisting conditions
- Reduced by prior creditable coverage
- Must provide certificates of creditable coverage
Individual Market (ACA-compliant plans)
- No preexisting condition exclusions
- Guaranteed issue during open enrollment
- Special enrollment for qualifying events
Note: ACA-compliant plans in Texas cannot exclude preexisting conditions, but short-term plans may.
Texas Mandated Benefits
Texas requires certain benefits in health insurance policies:
Required Coverage
| Mandated Benefit | Requirement |
|---|---|
| Diabetes Supplies | Must cover equipment and supplies |
| Mammograms | Annual screening covered |
| Reconstructive Surgery | After mastectomy |
| Colorectal Screening | Age-appropriate screening |
| Childhood Immunizations | Covered without cost-sharing |
| Mental Health Parity | Equal to medical benefits |
| Maternity Coverage | Required in most plans |
Mental Health Parity
Texas requires mental health parity in group health plans:
- Mental health benefits must equal medical benefits
- Same deductibles, copays, and limits
- Includes substance abuse treatment
- Applies to group plans
Texas Health Insurance Marketplace
Texas uses the federal marketplace (HealthCare.gov):
Key Features
- Open enrollment annually
- Special enrollment for qualifying events
- Premium tax credits based on income
- Cost-sharing reductions for Silver plans
Enrollment Periods
| Period | Timing |
|---|---|
| Open Enrollment | November - January (typically) |
| Special Enrollment | 60 days from qualifying event |
Qualifying Life Events
- Marriage or divorce
- Birth or adoption
- Loss of other coverage
- Move to new service area
- Income changes affecting eligibility
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Test Your Knowledge
What is the minimum grace period for annual premium health insurance policies in Texas?
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Test Your Knowledge
Which marketplace does Texas use for individual health insurance under the ACA?
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