• Some situations require time away from the condition in order to qualify.  For simple situations, a 6 month period sign, symptom, and treatment free is a good estimate.  This can also pertain to medication.  

• It is not uncommon to be declined by one carrier and accepted by another even though the carriers have very similar underwriting requirements.

• If we are declined by a carrier, we may lose our Short Term option.  If there is an issue, and you have no coverage, we recommend getting Short Term coverage first and then apply for the permanent plan. 

• Brand name medication are heavily scrutinized these days due to the cost associated with their use.  

• If you are currently on Cobra, it typically makes sense to apply for coverage as there is no down side.  You can remain on your Cobra if the coverage is not approved.  Cobra is usually quite expensive.
• The carriers can offer a split approval where one member is not approved but the rest of the family is.
• The carriers are mainly looking at current/recent and ongoing situations.  We all have a medical history but situations that are stable, from which time has passed, typically do not cause problems.
• If you are exhausting or losing Cobra (continuation of group coverage) you may be eligible for HIPAA.  Please check with us if this sounds applicable.
  
  Some common reasons for declination/deferrals of coverage
  • currently pregnant or an expecting father 
  • multiple medications especially brand name
  • recent (last 6 months including physical therapy) injury
  • recent (last 2-3 years) treatment for heart disease, diabetes, cancer, immune system disorders, or any other serious medical condition
  • height/weight outside guideline range
  • multiple conditions/injuries/illnesses

  If you have questions about your preexisting conditions whether listed above or not, please call us at 800/320-6269 or email us to receive personal assistance from a licensed California health agent. We will be able to advise you based on your specific medical history. 
  
  More information on Enrolling and qualifying for Individual and Family California health insurance:

  
  
  Enrolling in a Individual Family Health Plan
  1.  What is needed to start the process
  2.  How long does it take
  3.  Do I submit payment with the application
  4.  Is there a fee to apply
  5.  Do I need a physical
  6.  How can I expedite this
  7.  Am I locked in for a period of time
  8.  How is payment handled
  9.  Can I change my plan later
  10. Why should I go with you 
   

  What is needed to start the process

  We basically need the completed health insurance application (download here or have a hard copy sent to you), and the first payment to the carriers for at least one month's worth of premium.  If there are medical records needed, they will request them directly from the doctor.  This completed information can be expedited by faxing (831-624-2902) us a copy of the app and check, and then sending the original in the mail:    Goodacre Insurance Services   316 Mid Valley Center #283   Carmel, Ca 93923  Blue Cross has an online application and credit card option as well.  More information on applying for health insurance.         back to top

  How long does it take

  There are two different scenarios.  If the applicant is in good health and there isn't much the health carrier wants to check into, we usually hear back in one to two weeks.  If the volume of applications is running high in underwriting, the time frame can be longer.  If the carrier wants further information on something listed in the application, they will request records directly from the doctor and this can delay the processing time.  It usually adds another 2-4 weeks depending on how quickly the doctor responds back to the request.   back to top

  Do I submit payment with the application

  The first month's premium must be submitted with the application.  This can be done with a check made out to the carrier or via credit card (for Anthem Blue Cross, Blue Shield of California and Health Net).  If the application is not approved, this initial payment will be fully refunded.  back to top

  Is there a fee to apply

  There is no fee to apply.  Only the initial month's premium is submitted with the application.  back to top

  Is a physical required

  A physical is not required...only the completed application and first months premium.  Blue Shield may require a physical for applicants over the age of 55 who have not had one in the last two years.  back to top

  How can I expedite the processing

  Anthem Blue Cross has an online application which tends to process very quickly.  Otherwise, you can fax your completed application and copy of check (or credit card section) to 831-624-2902 to start the process immediately.  You would then mail the original if paying by check.  The credit card option just requires the faxed copy.  back to top

  Am I locked in for a period of time

  No.  The policy can be cancelled or renewed (by payment) month to month.                                                                                                       back to top

  How is payment handled

  There are a few options for payment with either carrier. Billing - Shield monthly, quarterly    Blue Cross bi-monthly, quarterly Credit Card Blue Cross allows monthly, bi-monthly, quarterly credit card deduction Checking account auto-deduction monthly deduction.   back to top

  Can I change my plan later

  Downgrading is easy to do within the same kind of plan such as Share 500 to the Share 1500.  Upgrading is possible if you are in good health as it is subject to underwriting.   back to top

  Why should I go with Goodacre Insurance Services

  We concentrate on health insurance for California

   

  Consumers: Individual Health Insurance Underwriting/AB 356
  
    Guide provided by http://www.insurance.ca.gov/  Link here

  
  Individual health insurance is insurance you buy on your own, rather than having it provided by your employer.  Please examine your options carefully before declining group coverage or continuation coverage, such as COBRA, that may be available to you.  You should be aware that California companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely.

  If you are in the market for individual health insurance, most insurance companies have online tools to help you find out how much individual health insurance will cost.  If you have a chronic illness or other health condition, it can be hard to buy individual California health insurance.  If you have applied for individual health insurance and been denied, the information below may help you determine why you may have been denied and if that denial was appropriate.

  Medical Underwriting

  When you apply for individual health insurance, the California health insurance company uses a process called medical underwriting to look at your age, sex, and health history to decide whether it will cover you and how much it will cost to provide you coverage.
  
  Do all health insurance companies have the same underwriting guidelines for offering insurance?

  No.  Each insurance company has its own underwriting guidelines, which are usually not made public.  However, insurance companies marketing and selling individual health insurance policies in California must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance (Insurance Code Section 10113.95 which was added by Assembly Bill 356 in 2005).   We have summarized the information that companies have filed in the questions and answers and chart below.

  • Health conditions that would automatically not be approved;
  • Health conditions that may not be approved;
  • Height and weight standards;
  • Health history, health care service utilization, and lifestyle or behavior that may cause the insurance company to deny insurance, limit the products they offer, or charge more for the coverage.

  What health conditions will cause a health insurance company to automatically refuse or deny my California health application for insurance?  

  There are many medical conditions that may cause an insurance company to automatically deny or not approve your application.  These may include the following:

  • Health problems for which you have not seen a doctor;
  • Health problems that a doctor cannot explain;
  • Health problems for which you have not completed treatment.

  An insurance company may also automatically deny your application for the health conditions below.  There may be other health conditions that are not on this list.
  
   

  • AIDS;
  • Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;
  • Cancer, under treatment;
  • Sleep Apnea;
  • Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities;
  • Heart disease;
  • Renal failure or Kidney Dialysis;
  • Diabetes with complications;
  • Cirrhosis;
  • Multiple Sclerosis;
  • Muscular Dystrophy;
  • Systemic Lupus Erythematous;
  • History of transplant;
  • Lymphedema;
  • Current infertility treatment;
  • Hepatitis;
  • Hemochromatosis.

  What will cause an insurance company to offer me insurance at a higher premium rate or limit the products or benefits I can get?

  Insurance companies may offer you insurance at a higher premium and/or limit the products or benefits you can purchase if you had a health problem in the past but you have recovered or you have been without symptoms for some time.  Insurance companies will also do this for minor health problems that you had in the past or may currently have.  Insurance companies argue that these conditions pose a risk that it will cost more for your health claims than if you were completely healthy.  Each application and insurance company is different.  An insurance company may charge a higher premium or limit the products offered for the health conditions below.  There may be other health conditions and time frames that are not on this list.

  • Stroke, after 10 years with no reoccurring problems;
  • Allergies, while testing is in process;
  • Ear infections, controlled with medications;
  • Lyme’s disease, without symptoms after one year;
  • Breast Implants (non-silicone);
  • Ringworm;
  • Joint sprain or strain, recovered and no restrictions;
  • Migraine headache, mild and infrequent with no emergency room visits;
  • Mild depression.

  Will a California health insurance company look at my height and weight when I apply for insurance?

  Yes.  Insurance companies usually look at your height and weight when they decide to offer insurance.  They may offer you insurance at a higher premium rate or refuse to insure you if you are overweight or obese.  Some insurance companies use a measurement called the Body Mass Index (BMI) to decide.  If your BMI is above 39, most insurance companies will not offer you insurance.  If your BMI is 30-39, an insurance company may offer you insurance at a higher premium.  If you have health problems because of your weight, such as diabetes or heart disease, an insurance company may refuse to insure you, even if your BMI is under 30.
   

  Can a health insurance company look at my smoking and drinking history when I apply for insurance?

  Yes.  Insurance companies may look at smoking and drinking history when they decide whether to offer insurance. 

  The following chart summarizes underwriting information that health insurance companies have filed with the Department of Insurance.
  
  
   

  AB 356:  Summary of Underwriting Information filed  re conditions for which no insurance coverage will be offered, application will be denied, or higher premium may be charged or benefit may be limited

  Condition	Insurance Company Action
  Health problems for   which   you have not seen a doctor	Automatic decline for some companies
  Health problems that a doctor can not explain	Automatic decline for some companies
  Health problems for which you have not completed treatment	Automatic decline for some companies
  AIDS	Automatic decline
  Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process	Automatic decline
  Cancer, under treatment	Automatic decline
  Sleep Apnea	Automatic decline or higher premium will be charged
  Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities	Automatic decline
  Heart disease	Automatic decline
  Renal failure or Kidney Dialysis	Automatic decline
  Diabetes with complications	Automatic decline
  Cirrhosis	Automatic decline
  Multiple Sclerosis	Automatic decline
  Muscular Dystrophy	Automatic decline
  Systemic Lupus Erythematous	Automatic decline
  History of transplant	Automatic decline
  Lymphedema	Automatic decline or higher premium will be charged
  Current infertility treatment	Automatic decline
  Hepatitis	Automatic decline
  Hemochromatosis	Automatic decline
  Rheumatoid Arthritis	Automatic decline
  Stroke, after 10 years with no reoccurring problems	Automatic decline or higher premium will be charged
  Allergies, while testing is in process	Automatic decline or higher premium will be charged
  Ear infections, controlled with medication	Higher premium may be charged
  Lyme's disease, without symptoms after one year	Automatic decline or higher premium will be charged
  Breast Implants (non-silicone)	Automatic decline or higher premium will be charged
  Ringworm	Higher premium may be charged
  Joint sprain or strain, recovered and no restrictions	Higher premium may be charged
  Migraine headache, mild and infrequent with no emergency room visits	Higher premium may be charged
  Mild depression	Automatic decline or higher premium may be charged
  Obesity	Automatic decline or higher premium may be charged
  STD (Sexually Transmitted Disease)	Automatic decline or higher premium may be charged

   

  Of course, if you have questions, please contact us.  That's what we are here for.
  
  email:  help@calhealth.net

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