Am I Insurable?

Individual and Family health insurance is different from Group (Company) insurance in that they can decline and or change rates based on your health at the time of application.  Below we have some common reasons for difficulties in getting approved but first a few quick tips regarding qualifying for coverage.
 

• 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

  More information on Individual and Family California health insurance

  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 Anthem Blue Cross requires 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, Anthem Blue Cross has 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.