“We Believe Health Insurance is A Right Not A Privilege”
Underwriting can get very intense on individual health insurance policies. Many people think that the stories of health insurance companies underwriting are untrue or exaggerated but I am here to tell you that it is very difficult to get improved with no qualifications on your policy, meaning no exclusionary riders or rate increases.
Recently there was a news story about a rape victim being denied coverage for a particular exam due to her being a victim of rape which is just an example of how vicious these health insurance underwriters can get.
East Coast Health Insurance
“We Believe Health Insurance is A Right Not A Privilege”
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Please send your Health Insurance Underwriting Questions to East Coast Health Insurance or call us anytime @ 888 803 5917
Firstly as my wife (who is one of the owners of East Coast Health Insurance) often tells our health insurance agents when they ask the same underwriting question for the millionth time, “Go Check The Underwriting Guidelines!” So rather then go into a long winded explanation of the different health insurance companies and their various underwriting guidelines in different states I figured why not just post the underwriting guidelines themselves? It will be the first time it has ever been done in one place.
Health Insurance Company Underwriting Guidelines
- Cigna UW Guidelines
- United Health Care UW Guidelines Updated 10.2009 UHC
- Aetna Underwriting Guidelines Aetna UPDATED May 2009
- Humana Underwriting Guidelines
- Blue Shield of California Underwriting Guidelines
- Health Net Underwriting Guidelines
- PacifiCare Underwriting Guidelines
- Vista South Florida Underwriting Guidelines
- Avmed Florida Underwriting Guidelines
- Blue Cross Blue Shield of Florida Underwriting Guidelines BCSBF UPDATED July 2009
Ask Us Your Underwriting Questions on Individual Health Insurance Policy Underwriting
Question: I have been diagnosed with APNEA and I use a CPAP (AIR PUMP) every night with great results. Now, my previous insurance advisor tells me that United will not take me with that condition. Is that true? It does not make any sense to me so I told her that I would look around by myself (that means, asking you for a policy that covers my wife and myself together).
I did check the underwriting guidelines for United and indeed it indicated that Sleep Apnea is a declinable condition. Humana riders out the condition as you currently have it controlled with CPAP; if it was surgically corrected you would have a preferred rating with Humana. I would also suggest trying Aetna, although they could rate up your premium up t o150% we can see how they come in on their final proposal after the underwriting process. Please note that with Humana if you have High blood pressure or a ratable build along with the sleep apnea, then it would be a decline. The condition on its own is ridered out, but couple that with another condition and they would probably decline you. I know that sounds terrible, but all insurance companies are pretty strict with the individual underwriting.
Questions Are PPO’s allowed to issue Exclusionary Riders and Rate Ups on Individual Policies?
yes PPOs are allowed to issue exclusionary riders and rate increased on an individual’s policy. HMOs and POS cannot since they are filed as an HMO and as per state law cannot issue exclusionary rider but can impose rate increases. This is not the same thing as the 24 month pre-existing clause in which states that for either 12 months or 24 months depending on the company – that they will not cover any pre-existing condition if you do not have proof of creditable coverage. Although, some health insurance companies have somehow been able to issue policies and still impose a 12 month waiting period regardless of whether or not they had creditable coverage within 62 days of obtaining new coverage.
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