Guaranteed Issue Health Insurance
What is guaranteed-issue health insurance? Normally, when you submit any proposal to your insurance company for your health insurance, your application goes to a medical underwriter to determine whether you are healthy enough in order to qualify for coverage. Therefore, your request for health insurance depends upon the outcome of medical underwriting.
However, the Health Insurance Portability and Accountability Act (HIPAA), offers an opportunity to individuals, who recently lost their group health plan benefits which was offered to them as part of their employment benefit, even if they have a preexisting condition.
If you are one of these individuals, all health insurance companies who offer individual health insurance plans are required to offer you insurance irrespective of your previous medical record. This mandatory condition to issue insurance to an eligible individual is called guaranteed issue. As per these rules, no insurance company can decline to offer you coverage on medical grounds. This law was passed by the federal government in 1996.
Who Is Eligible For A
Guaranteed-Issue Health Insurance Policy?
You are eligible to qualify for a guaranteed-issue health insurance policy, if:
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You were previously covered under any employer sponsored group health insurance plan, church plan or governmental plan but now you don not qualify for that plan or any other group health insurance plan.
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You have already exhausted continuation of coverage benefits such as COBRA.
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You have one and a half years of coverage without any break in service of a period more than 63 days in which you did not have any group or COBRA insurance; or
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You were given individual medical coverage because of withdrawal of your insurer from your area and you lost coverage, or your current plan was not available in the county where you moved within the state.
What Do You Qualify For?
If your last group coverage was an insured medical plan, you would qualify for a choice of plans that “convert” you to individual coverage, called a conversion plan. You may qualify for guaranteed issue individual plan from any insurance company offering plans to individuals if you were previously covered through a self-insured group plan or through an employer sponsored group plan. Such insurance company would however, offer you its two of the most popular plans currently being offered by it.
In some states an exception is used if the administrator of any self-insured group health insurance plan offers a conversion choice that complies with the respective state law. However, in such case, you will have to forego your qualification for any other guaranteed issue health plan except for a choice between the conversion options mentioned above.
Protections Offered By A
Guaranteed Issue Individual Policy
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Credit for prior coverage: If you have been covered for 18 months without a break of 63 days or more, you would not need to go through waiting period for pre-existing condition to start your individual policy. In this case, your previous coverage of 18 months serves as credit against the longest waiting period that an insurance company may ask you for a guaranteed issue policy. Any such previous coverage of your spouse or dependents also serves as a credit.
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Coverage for a pre-existing condition: The coverage for any pre-existing condition for you or your dependents or your spouse may not be excluded by issuing a ride to the plan.
Coverage For A Newborn Or Newly Adopted Child
If your child born or was adopted within the last one and a half years, the child does not needed to meet the prior coverage requirement. The child is eligible for benefits on the day the policy begins.
Know Your Health Insurance Options
Therefore there are options for your health coverage even if your request for health insurance has been declined by your insurance company. In fact, you may qualify for the guaranteed issue option.
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