California health
insurance
-
Individual California health insurance
-
Health underwriting for Individual and FamilyCalifornia
Individual Health Insurance Underwriting
ACA UPDATE: The individual rating
tiers no longer apply to the California market
as of Jan 1st 2014.
Information below pertains to old market
rules which no longer apply are available for
old grandfathered plans only.
To quote the new plans standardized ACA
rates and tax credits, click on
Individual
health quote including Covered Ca
There
will be many changes to the California health
insurance market as a result of Health Reform
but for the time being, we still need to
understand the concept of medical underwriting.
It sounds pretty dire but really, it's the
process of qualifying for medical insurance
based on health. For many people new to the
process (say coming off of group health
insurance which isn't generally medically
underwritten), it can be a daunting concept.
Most people we speak with bring up their
concerns about qualifying for health insurance
after hearing stories from friends and
relatives. Let's see if we can shed some light
on the process, what to expect, and options if
we are unable to qualify based on health.
Keep in mind that we are focusing on the
individual/family pre-65 California health
insurance market. Group health insurance in
California will likely be guaranteed issue if we
meet certain requirements (participation, # of
employees, etc) and Medicare has open windows
during which you can enroll in Medicare
supplements regardless of health for individuals
over age 65 and the disabled under 65. We're
looking at the pre-65 private market where
underwriting still occurs. So what's
involved?
These days, we usually get a decision back
with just the completed application (online or
paper) and a phone interview which occurs 3-5
days after the application is received. A
paramedical exam is almost never needed for the
process and the request for medical records from
doctors has decreased significantly in lieu of
the phone interview. We'll usually get a
decision with our priority processing in about
5-7 business days so you can expect the process
to run roughly 2 weeks which coincides nicely
with the recent requirement that effective dates
be no earlier than 15 days following online app
submittal. So we're basically looking at the
health history questionnaire with approximately
30 questions and the phone interview with a
nurse. Ideally, have the necessary information
(dates, prescription names and dosages, and
results) ready before completing application but
you can always save your progress and continue
later. Everyone has some kind of health history
so how do the carriers look at different
situations?
First of all, children are now guaranteed
issue which means they can't be declined based
on health but they can have a higher tier
(essentially rate) applied to them which can be
very high. Of course, if they're in good health,
they can qualify for the best rate. In
principle, a given carrier does not underwrite a
certain plan differently from any other plan.
The difference is in the rates. That being said,
if you're medical care is primarily maintenance
brand name medications, choosing a generic only
plan might have some impact depending on the
underlying condition. The carriers are really
looking at recent issues or more serious
problems from the past. They abhor the unknown
so any request for follow up care which has been
completed can be an issue. Recent changes in
care can also pose problems as they like to see
a track record so they can adequately assign a
risk (and approve coverage). Try not to check
the "all or none" family member box in case some
family members have difficulty while others
might be approved. People's potential health
situations are too varied to discuss in one
article so it's best to discuss with our
licensed agents to get a better sense of your
options. What if we can't qualify for coverage?
There are some back up options available for
those unable to qualify for individual
California health insurance. If you have not had
coverage in the last 6 months, there's the new
PCIP plan through the Federal government.
Otherwise, you can check into MRMIP or AIM (for
expecting mothers) through the State. These
assume that you do not have a Cobra or HIPAA
option after exhausting group health insurance
and the resulting Cobra. Never lose those
options until you have other approved coverage
in force.
Now all of this will change come Jan 1 2014
and the whole term of individual California
health insurance underwriting will become more a
question of filling forms as opposed to
qualifying based on health but there may be more
qualifying for subsidies based on income which
will add a new dynamic. On one hand, the concept
of medical underwriting will dissipate if not
disappear but the rates will likely increase
significantly based on what we've seen.
You can run your
California
Health Plan Quote here
to view rates and plans side by side from the major carriers...Free.
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!