Eligibility Requirements for Private Family Health Insurance Plans

Depending on the state in which you reside, providing medical insurance coverage for your family under an individual health insurance plan may not always be possible. This is because the insurance regulations in most states allow the insurance companies to be selective about whom they approve for acceptance on family and individual health insurance plans. Although this may not seem fair, there is a logical explanation that supports this regulation. If families could obtain an individual heath plan at anytime they wanted, the majority of people would only obtain coverage when they needed it. This would mean that the medical insurance companies would only be insuring family members that were in need of medical attention, which in turn would dramatically increase the insurance premiums that must be paid by all.

Eligibility Guidelines Can Be Strict

Many families are often surprised at how strict the insurance companies can be in choosing who they are willing to approve for health insurance coverage. What may seem like a minor medical condition to some people could easily result in a decline of coverage. This is primarily due to the high cost of health care and prescription drugs. Another factor is that many medical conditions can be directly related to risks associated with acquiring other, more serious medical conditions. Obesity is a prime example of this. Although a person may be overweight with absolutely no medical conditions, the insurance companies are concerned about the risks associated with obesity, such as diabetes and heart conditions. Most insurance companies have height and weight guidelines based on the body mass index. Insurance companies can reject an applicant if their BMI is above a level determined by the insurance company.

Not All Family Members May Be Approved

When applying for a private family medical insurance plan, it is not uncommon for the insurance company to decline one or more family members and approve the other family members. They look at the health history and risk factors for each family member individually, even if they are all included on the same application and applying for the same health plan. When this occurs, you will need to decide if you wish to accept coverage for only the approved family members or try applying with other health insurance companies that will accept all family members. You will need to consider your options for Splitting Family Members to More Than One Policy by obtaining rate comparisons for the family split options associated with the denial of a family member. If your family is currently without medical insurance, it is always advisable to accept coverage for the family members that have been approved. You can always re-apply with a new insurance company and cancel your accepted coverage if you find a health plan that will insure all family members together. Do not cancel your recently acquired health care coverage until you have been accepted under a different health plan.

Rate-Up

Another possibility is that one or more family members may have a medical condition that results in a "rate-up." This means that the health insurance company views their medical condition as a risk, but not a substantial enough risk to fully deny that family member coverage. The insurance company may increase the quoted premium amount to offset the increased risk from insuring that family member. In this case, it is often beneficial to split that family member off onto their own policy so that the entire family premium is not affected by this rate-up.

Uninsurable Family Members

If you have a family member with a serious illness, they may be uninsurable through any private family health insurance plan. In this case, there may be government sponsored "high-risk" programs that will insure them. If the family member is a child, your State Children's Health Insurance Program (SCHIP) may be a viable option. Visit Section 3, Family Health Insurance Through State-Sponsored Programs for more information about SCHIP.

Note: The information and advice provided in this Guide to Family Health Insurance may not provide the best advice for every situation. The best options for your family medical insurance may be unique and require the advice of a local advisor. We highly recommend that you consult with more than one insurance broker in your state to gather and compare alternative opinions. The owners of HealthInsuranceFinders.com are not responsible for any decisions you make in regards to your family's health insurance through the information provided in this guide.