Rescission of health policies
with California health insurance
There has been stories in the
news regarding carriers
rescinding (or canceling)
coverage after approval.
It immediately strikes up fears
that the general public has
regarding health insurance
carriers and their practices.
Let's take a look at these
specific situations and how to
avoid having your
California
health insurance plan falling
into similar although rare
jeopardy.
First, let's what about the
situations in the news?
From what we understand, the
specific situations involved health
information (regarding existing or
pre-existing conditions) that were
excluded from the medical
questionnaire on the health
application. This is
almost always the issue with
rescission. Equally concerned
about this situation, we asked the
carriers for an explanation.
What was not reported often in the
media is that the court ruled that
the carrier has to prove the
applicant knowingly or intentionally
withheld critical medical
information in order for the carrier
to rescind or withdraw health
coverage. This is very
difficult to do. The carriers said
that rescission was only used in a
small percentage of very serious
abuses. Let's discuss how to
avoid this all together.
Steps to take in order to avoid
rescission of your health plan
First, choose a strong carrier.
There are sub-par carriers and
association plans that we do not
feel as confident about...both in
their practices and their ability to
be long term partners. We only
quote California health insurance
carriers on this site that we trust
on both accounts.
Secondly, be thorough, honest, and
complete when filling out the
California health
application. This is
especially true for the
medical
questionnaire part on the app.
Prospective applications will ask if
they should leave off information
that may increase their rate or have
coverage denied to them altogether.
The answer is a resounding "NO".
If you not put the information on
the application, it can result in
rescission of your coverage.
Even worse, the omittance of
information usually shows up when a
serious health situation occurs
which is tied to the pre-existing
condition left off. It's a
very bad situation and one to be
avoided at all costs. If you
are honest and complete with the
application, you can feel safe going
forward if something happens
health-wise.
Pregnancy and the "grey area" when
qualifying for health insurance
Pregnancy is a little tricky.
If you are pregnant or have missed a
monthly period for a period of time
(carriers have different ways of
addressing this), you will be denied
individual health insurance
(Small Group can be guaranteed
issue). The OBGyn will
calculate back the date of
conception based on fetus size
during one of the ultrasounds.
There can be situations where you
are in a grey area...at the time of
completing the individual/family
health application, you had not
missed your period more than the
allotted time and did not know you
were pregnant but your date of
conception is very close to your
effective date and/or your signature
date. Our advice is to avoid
these situations and do not lapse
coverage. Even if you are
honest, it is nerve-wracking to be
in this grey area so make sure
there's plenty of time spaced
between effective date date of
conception. If you are already
pregnant, check with
AIM as option through the State.
More information on completing
health history section
A
common question from applicant is
"how much information should I put
down?". Be thorough.
We would rather you provide too much
information than not enough.
The carrier is very concerned about
ongoing and recent situation of any
severity and more serious issues
from the past. Read the
questions and the initial
explanation very carefully to
understand their requirements and
time constraints. It's
important to provide the results (or
status) of a pre-existing condition
and to give the best information in
terms of beginning/end date of the
given situation. Not only is
this required but it is your
interest to give the health
underwriter a good idea of what is
involved. They can then
request medical records if more
detail is needed.
If you feel your coverage has
unfairly rescinded, you can address
the carrier directly or contact the
Department of Insurance.
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