What is guaranteed issue?
Common types of guaranteed issue coverage are HIPAA plans, risk pools, group health plans and COBRA coverage. Under federal law, all states must have a “guaranteed issue” health insurance option for any person that is HIPAA eligible. In many states, this type of guaranteed coverage is offered through the state’s high-risk pool, while in other states HIPAA coverage must be offered by individual health insurance carriers. Other types of guaranteed coverage apply to group health insurance. Any person eligible for coverage under a group health plan may not be denied coverage based on their personal health history. The same hold true if that person leaves the group plan and has an option to go on COBRA coverage. The insurance company may not deny a person their right to accept COBRA coverage, regardless of their claims history or health risks. It is also important to understand that just because you are enrolling in a “guaranteed issue” medical insurance plan, the insurance company will not automatically pay for any treatments for your pre-existing medical conditions. Unless your have had continuous coverage, and are HIPAA eligible, the insurance company may still have the right to exclude payment on a pre-existing condition for a specific period of time. This exclusionary period may vary based on state regulations, but is commonly set at 12 months. 2 CommentsLeave a comment |
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What is guaranteed issue?
When a health insurance policy is referred to as “guaranteed issue,” this means that the insurance company will not decline your application for medical reasons. In most cases, individual health insurance policies are not “guaranteed issue” and the insurance company may decline your application for insurance if they feel you are high-risk because of past health history or current health status. Some states, such as New York, require that any insurance company selling individual health insurance in that state must guarantee issue any person that applies for coverage. There may be other factors that allow the insurance company to deny your application, even if you are applying for guaranteed issue coverage. For example, you may still be required to be under the age of 65, a resident of the state or a legal resident. Guarantee issue does not necessarily mean the insurance company must offer coverage to anybody who applies. It simply means that they can’t deny your application based on your medical history.
About guaranteed issue, I am an agent and always advise clients to be careful about moving states if they are on a guaranteed issue plan. Especially if they are a close to 65 and waiting for Medicare. As far as I know there are only a few states that guarantee issue for preexisting conditions such as the state of New Jersey. In those states that have guaranteed issue, premiums are likely to be very high, meaning they could go up to even $3000 a month. The insurance company will charge what they think you will cost them. So, it is something to think about if you are moving states. Then again if you have group coverage and move to another job in a different state that also offer a group plan, as long as you have had coverage for at least 12 months and no more than 63 days without insurance, you can join the new plan with your preexisting conditon.
Comment by Jerry — June 12, 2009 @ 12:40 pm
Yeah I found out about this when I moved from Connecticut to New York. I am a temp worker who does not get insurance through my employer and I was in for a rude awakening when I arrived in New York. GoldenRule won’t even do business in New York, and the few policies available in the health insurance individual market have unreasonably high premiums.
Why cant the federal goverment step in and allow individuals to cross state lines when buying health insurance?
Comment by Tom — December 15, 2009 @ 1:10 pm