Alabama Health Insurance (AL)

Alabama (AL)
Individual Health Insurance Regulations

Learn more about Alabama Individual Health Insurance

Alabama does not require health insurance companies to sell standard policies that are written or regulated by the state. Insurers may design their own health plan options and include the benefits, deductible and coinsurance limits that they choose. Certain benefits, such as screening for breast cancer, and mandated by the state. For individual health plans, the insurance companies have the right to deny your application based on your health status, either present or historically. If you have a pre-existing medical condition, the insurance company may take one of three actions, 1) they may decline to offer you coverage altogether, 2) they may offer you coverage but exclude paying for treatment of your condition, or 3) they may accept your coverage and agree to include coverage for your pre-existing condition. The decision of the insurance company is often based on the severity of the medical condition and the anticipated costs in maintaining and treating that condition. Even if an insurance company does not request and exclusion rider at the time of your acceptance, Alabama law permits them to exclude pre-existing conditions for up to 24 months and they are not required to recognize creditable coverage from prior health insurance coverage. The look back period for pre-existing condition determination is 5 years.

Alabama Small Group Health Insurance Regulations

If you are a qualified employee and offered health insurance through your employer, the insurance company may not refuse you coverage, regardless of your health status. Your employer may request a waiting period from your date of hire before you are qualified to join the group health plan. This waiting period must be the same for all employees working for that company. HMO companies in Alabama are also permitted to impose a waiting period on new hires, but it may not exceed 2 months. Insurance companies may place an exclusion on pre-existing medical conditions for a specific period of time but they must give credit toward prior health insurance toward this waiting period if that coverage was continuous without a lapse of more than 63 days. The Family Medical Leave Act applies to companies with more than 50 employees and protects your health insurance coverage under the group plan for 12 weeks.

COBRA and Continuation Coverage

Alabama does not have a state mini-COBRA regulation. However, employers with more than 20 employees must recognize federal COBRA laws. You may remain on your previous employers group health plan and receive the same level of coverage for a period of 18 months. You will be responsible for paying the premium amount that was previously paid by your employer, plus a 2% administration fee. If the insurance company raises the premium on your employer's group plan, you will also be subject to those higher rates. Once you exhaust your COBRA option, and you are not eligible for individual health insurance, you may qualify for coverage under the Alabama Health Insurance Plan.

Additional Alabama Resources

• Alabama Health Insurance Plan
  AHIP provides health insurance coverage to Alabama residents that have exhausted their COBRA coverage or have lost access to COBRA and have had 18 months of continuous coverage. To qualify, your most recent coverage must have been under an employer sponsored group health plan.
• Alabama ALL Kids Program
  This state-sponsored program aims to provide health insurance to children who are residents of the state and are not eligible for Medicaid and are unable to obtain insurance through any other means.
• Alabama Medicaid Agency
  Provides health insurance coverage to low-income families and offers programs that include family planning, long-term care, maternity care, mental health services, pharmacy benefits, hospital services and more.

AL Medical Insurance Statistics

Total Population: 4,524,000
With Health Insurance: 3,828,000 / 84.6%
Without Health Insurance: 696,000 / 15.4%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: There perecentage of Alabamans without health insurance increased by 1.9% from 2004

Alabama Department of Insurance
Phone: 334-269-3550
Receives, researches, investigates and resolves individual consumer complaints against insurance companies, agents and brokers and provides educational materials and assistance for consumers and senior citizens regarding insurance questions and coverage provisions.

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