Your medical history plays the role in determining your insurability. All insurance companies today have a list of deniable conditions that automatically will result in a decline of coverage from them. You can as well be declined for a combination of conditions that can make you fall into the same category of declinable by the insurance company. Deniable conditions for example are build (height/weight), diabetes, cancer, heart attacks, heart issues, bi-polar, and sleep apnea just to name a few.

This is a common issue of people that have some medical history or a few medical issues concurrently find out individual health insurance is different than group plans. While the individual was on a group plan they never would know that their previous diagnosis could be problematic for them in the future. You can avoid this issue of being denied coverage by working close with your personal health insurance agent. The difference between the Group Plan and Individual Plan is that the Group Plan needs to accept all the employees even with medical conditions, the individual plan does not. This is one thing that President Obama is trying to address.

Why do people move from group to individual coverage? This change occurs when changing jobs, or losing ones job for example. Some employers do not offer group health insurance and would require the individual to obtain their own health coverage. Before you apply, consult with you agent and you can have them do a underwriting prescreen for you. It is always best to approach it this way to prevent the insurance company issuing a denial.

What Can You Do if You have Been Denied Coverage?

I would recommend you talk to your health insurance agent if you have not already talked with them. They will be able to listen to your particular situation and recommend the best options for you. The best option would be to obtain coverage from your State High Risk Pool. If that is not an option for you there are limited benefit plans available, but beware these are not health insurance. Careful consideration should be taken before you purchase a limited benefit plan and ensure you understand what you are purchasing.

In Texas, we have the Texas Health Insurance Risk Pool (TRP) if you are not living in Texas check to see if your state has a Health Insurance Risk Pool available that will offer coverage to anyone who has been denied coverage by an individual insurance company. This is major medical coverage that can be obtained by individuals once they have exhausted all COBRA benefits offered. This is required before you apply for your Texas Risk Pool coverage. The Texas Risk Pool premiums are determined by your age, location (zip code), and tobacco use. These are current Texas Health Insurance Risk Pool Rates.

Limited Benefit plans offer an indemnity plan (set amount per situation) to help you with medical expenses, and they are NOT HEALTH INSURANCE protection. The major medical plan provides protection to a lifetime Max of $2,000,000, the limited benefit plan is limited coverage. This option may be a good solution if you were not able to afford the Risk Pool costs and you are looking at going without any protection. Please be sure you understand what you are buying and what limitations the policy has. There may be a pre-existing condition waiting period for 12 month. Be sure that you look carefully. We have found a guarantee issue plan that has no preexisting conditions clause. This allows for this guaranteed issue product to offer coverage to everyone without a waiting period to get things covered. If you are interested in this product you can check out the Homeland Health Care link and the AWA NPX 1-4 products. Before you purchase please consult with us or your agent to ensure this is the best option for you.

Bottom Line

Your personal health insurance agent will offer you the best solutions for your particular situation. Do not go it alone without your agent’s advice and guidance to help you through this stressful time of having to find individual health insurance for you and your family. The strength you will get with working with an experienced insurance agent has the knowledge to help you navigate through the health insurance system. They will provide a level of personalized service you cannot get through purchasing through a web site link. They will know your situation when you call and you will be able to talk to the same person anytime you have a question or need help.