Jul
29
2019

You Have Been Declined for Health Insurance in California, Now What?

If you are reading this then you probably have been declined for health insurance in the recent past. When you get declined for health insurance it probably has something to do with your medical history. Since California is one of the underwritten states health care companies have the right to declined people for health insurance. Who health insurance company might decline and who it might not all depends on risk assessment using actuarial tables. Anytime when you fill out individual application for health coverage and answer yes on one of the medical questions your application might be manually reviews by one of the underwriters. It is a person who is responsible to reviewing application using actuarial tables. Actuarial tables are statistics done by the insurance companies, hospitals, doctors, researchers that predict the cost of insuring some one with a specific medical history.

Some states like New York, New Jersey and Washington require insurance companies to insure everyone. Those three states do not have medical underwriting and everyone is automatically approved for health coverage. In order to insure everyone with medical history insurance companies increase rates to the point where it becomes un-affordable to most people. What keeps the average monthly premiums low is low utilization of health care. If there are more people with high medical insurance utilization with a specific health insurance company they have to raise the rates for everyone in order to keep up with paying medical claims. That also drives people who do not use health insurance that often to drop health insurance all together and yet driving rates even higher. This leaves no choice for insurance carriers but to drive rates even higher. New York, New Jersey and Washington have highest premiums for medical coverage and a lot of families find health care out of reach.

In California if you have been declined for health coverage you have options. If you out of job or currently on low income you can qualify for Medical and if you have kids they can qualify for a program called Healthy Families. Most states including California have high risk pools that are designed for people who have been declined for individual health insurance. In California this program is called MRMIP. Just the quick search on the Internet will guide to a government website. MRMIP is a program that is managed by the state and your big name medical insurance providers participate in it. Chances are you will be able to keep the same health insurance company if you are already use to them. MRMIP program has limits and it might have a waiting period.

One of the best options might be when it comes to getting the most coverage for your money is through a group plan. In the state of California all group plans by law are required to be a guaranteed issue. That means that there is no medical underwriting. This options requires more work from you. Insurance companies are not just going to let you set up a group plan if you have been declined for individual health insurance. Since insurance companies are required to insurance everyone who is part of the group state requires insurance companies to have rules when it comes to setting up a group plan. Some of the basic requirements change from the insurance company to the insurance company.

The best way to find out is talk to insurance broker. The basics that insurance companies are going to be looking for are that you have to have a reason for starting a group plan other then getting medical insurance. It is illegal to start a group plan just to get health insurance. That means that you have to have a business and that could be anything. To have a group plan you obviously have to have more then just yourself It takes at least two people to start a group plan. All the people that are going to be on the group plan are either have to be the owners of the business or have to be on the payroll. Some insurance companies require either a DE-6 form or six weeks of payroll records. If every one if the owner then you will be required to provide proof of the ownership listing everyone that is going to be on a group plan as the owner. This might not be simple but is is certainly doable and it is definitely worth it if you do not have any coverage and cannot get it on your own.

It is always easier to just blame the insurance company that they have declined you for health coverage. If you have been declined and are looking for health insurance you just have to be more proactive in getting your coverage. Once you work with a broker on getting on the requirements on setting up a group plan then it is forever yours and no one can take that coverage away from you unless you stop paying for it.

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Jul
22
2019

What to Do If You Were Turned Down For Health Insurance

If you’ve been living without health insurance, you’re not alone. 15.9 percent of all Americans are uninsured as reported by the UHF (United Health Foundation). Sadly, sometimes even when people are trying to be financially and socially responsible they’ll find that they’re unable to qualify for a health insurance policy.

According to survey by U.S. Census Bureau, nearly 60 percent of the population gets health insurance in the form of group policies through their employer. There are other people who get covered by government-sponsored health care, such as children, the elderly, and those with low incomes. Until recently, however, those outside of these groups were largely at the mercy of the policies of for-profit insurance companies when it came to whether they could get coverage.

If initially turned down, ask again or apply with another insurance provider

If you find that you’re in this group that has difficulty getting coverage, the first thing you should do is to try to find out what happened. In some cases, you may be rejected due to an error on the part of the company. If the reasons for your rejection were minor, you may also still be able to get individual insurance through another company. However, if you have a major pre-existing condition such as Cancer or Diabetes, it’s unlikely that any insurance company will consider you a good risk and you’ll have to seek out other options.

State high risk health insurance pools as an option

It is for this reason that a national high-risk insurance pool will be created within 90 days following the passage of the March 2010 Health Care Reform Act for people with existing medical conditions. The pool is backed by $5 billion in federal subsidies, and will offer subsidized premiums to people who have been uninsured for at least six months and have medical problems that have resulted in their being rejected from other insurance options. In some cases these risk pools will be run through the state governments. Either way, the law says that these pools will remain available until the new health care reforms have fully taken effect in 2014.

Prior to this legislation, high risk pools were already available in 34 states and covered 183,000 citizens. From the perspective of someone who wants a policy, the important thing to note is that the quality of coverage offered can vary widely depending on the attitude and policies of the state offering them. Some states are just more generous than others in programs like this, and if you believe that you’re likely to need to use your health care policy regularly, it’ll be worth your while to get a sense of the kind of coverage that your state offers. You should also remember that even though you’ll already be paying higher premiums than a typical insurance plan, you’ll still have to make sure you have enough money in reserve to cover deductibles and co-payments or health care will be as unattainable to you as ever.

In extreme cases, if you find your state’s high risk pool to be a completely unacceptable option, you still have choices but none of them are easy. If you’ve been working at running your own business or at a small business, you may be able to get into a group plan if you can find employment at a large company. In an extreme case, if you know that another state offers a high risk pool option that would work for you, and you have the means to do it (such as family in that area), you could even consider relocating.

State risk pools and where to contact them

Alabama Insurance Plan

Toll-free 1-800-513-1384 or (334) 353-8924

Alaska Comprehensive Insurance Association

Toll-free 1-888-290-0616

Arkansas Comprehensive Insurance Plan

Toll-free 1-800-285-6477

California Major Risk Medical Insurance Program

Toll-free 1-800-289-6574 or (916) 324-4695

CoverColorado

(303) 863-1960 or toll-free 1-866-787-9129 (M-F 8am-5pm)

Connecticut Health Reinsurance Association

Toll-free 1-800-842-0004 (M-F 9am-4pm EST)

Florida Comprehensive Health Association (closed to new enrollees since 1991)

(850) 309-1200

Idaho Individual High Risk Reinsurance Pool

(link is to a PDF on program)

Toll-free 1-800-721-3272 (In-state only)

Illinois Comprehensive Insurance Plan

Toll-free 1-866-851-2751 (in-state only) or (217) 782-6333

Indiana Comprehensive Health Association (click “guest” for access, then choose “ICHIA”)

Toll-free 1-800-552-7921 or (317) 614-2000

Health Insurance Plan of Iowa

Toll-free 1-877-793-6880 (M-F 8am-5pm CST)

Kansas Insurance Association

Toll-free 1-800-362-9290 (M-F 8am-5pm)

Kentucky Access

Toll-free 1-866-405-6145

Louisiana Health Plan

Toll-free 1-800-736-0947 or (504) 926-6245

Maryland Insurance Plan

Toll-free 1-888-444-9016 (M-F 8am-5pm)

Minnesota Comprehensive Health Association

Toll-free 1-866-894-8053

Mississippi Comprehensive Health Risk Pool

Toll-free 1-888-820-9400

Montana Comprehensive Health Association

Toll-free 1-800-447-7828

Nebraska Comprehensive Insurance Pool

(402) 343-3574 or toll-free 1-877-348-4304 (M-F 8am-4:30pm)

New Hampshire Health Plan

Toll-free 1-877-888-6447

New Mexico Medical Insurance Pool

(505) 622-4711

North Carolina Health Insurance Risk Pool (NCHIRP)

Toll-free 1-866-665-2117

Comprehensive Health Association of North Dakota (North Dakota health insurance risk pool)

Toll-free 1-800-737-0016 or (701) 277-2271

Oklahoma Health Insurance High Risk Pool

Toll-free 1-800-255-6065 or (913) 362-0040

Oregon Medical Insurance Pool

Toll-free 1-800-848-7280 or (503) 225-6620 (M-F 8am-5pm)

South Carolina Insurance Pool

Toll-free Phone 1-800-868-2500, ext. 42757, or 1-803-788-0500, ext. 42757

South Dakota Risk Pool

605-773-3148 (ask for a Risk Pool representative)

Tennessee’s Tenncare Program

1-888-486-9355

Texas Health Insurance Risk Pool

1-888-398-3927

Utah Comprehensive Health Insurance Pool

Toll-free 1-800-705-9173 or (801) 442-6660

Washington State Health Insurance Pool

Toll-free 1-800-877-5187

West Virginia Health Insurance Plan

1-866-445-8491

Wisconsin Health Insurance Risk Sharing Plan

Toll-free 1-800-828-4777

Wyoming Health Insurance Pool

(307) 634-1393

Mark Anderson is a serial entrepreneur and a self-studied expert in buying individual health insurance [http://www.buyingindividualhealthinsuranceblog.com] and small business health insurance plans. Mark has started, operated and sold several businesses ranging from being a solo-entrepreneur to building a small businesses into a 35 person organization. Through this process Mark has become an expert in the field of medical health insurance for individuals and small business.

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