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Links to Site 3900 W. Charleston
Suite 170-X Office: 702.656.5915 Fax: 702.656.1454 |
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The following pages are intended to provide education on some of the various intricacies regarding Individual Health Insurance Plans. These pages are to be taken as guidelines, if there are any questions you can always contact us or your state's department of insurance for clarification for the laws particular to your situation. |
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Individual/Family Health Insurance In a "Nut-Shell"
If you do not have access to employer-sponsored group health insurance, you may want to buy an individual health insurance plan from a private health insurance company. As in most other states you have limited guaranteed access to individual health insurance. Whether you can buy an individual health plan may depend on your health status, the kind of coverage you want to buy, and other circumstances. Also, there are some alternatives to individual health insurance coverage such as continuation coverage (from COBRA coverage) or conversion policies. If you would like more information on Health Savings Accounts (HSA's) or Medical Savings Accounts (MSA's) please contact us at 877-81-INSUR.
When do individual health insurers have to sell me coverage?
In general, companies that sell individual health insurance are free to turn you down because of your health status and other factors. When applying for individual coverage, you may be asked questions about health conditions you have now or had in the past. Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers. In general, individual health insurance plans offering family coverage must automatically cover newborns, adopted children and children placed for adoption under the parents' health plan for the first 31 days. The insurer may require that the parent enroll the dependent within the 31 days in order to continue coverage beyond the 31 days. In general, mentally retarded and physically disabled dependents are permitted to remain insured under their parents individual health insurance policy after they reach the age at which dependent coverage is usually terminated, if certain conditions are met. The adult dependent must be incapable of self-support and must rely on the policyholder for support. In addition, proof of dependency and disability must be provided to the insurer within 31 days of the dependent reaching the limiting age. If you are federally eligible, insurers must offer to sell you two standardized policies. You may select from either a "basic" or "standard" health benefit plan. You can choose the policy you want and cannot be turned down because of health status. You may be offered other non-standardized coverage as well, but you may be charged more for that coverage To be federally eligible, you must meet certain criteria If you are federally eligible you are guaranteed the right to buy an individual health plan with no pre-existing condition exclusion periods. To be federally eligible, you must meet all of the following: You must have had 18 months of continuous creditable COBRA coverage, at least the last day of which was under a group health plan. You also must have used up any COBRA or state continuation coverage for which you were eligible. You must not be eligible for Medicare, Medicaid or a group health plan. You must not have health insurance. You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage. Federal eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by maintaining continuous coverage and rejoining a group health insurance plan.
Copyright 2004 - Knox Associates, LLC - All Rights Reserved |
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