Mississippi (MS)
Individual Health Insurance Regulations

Learn more about Mississippi Individual Health Insurance

Mississippi is not a guarantee issue state, which means that health insurance carriers medically underwrite individual health insurance policies. During the application process, the health insurance carrier will obtain information regarding your past and present health history. Based on this information, the insurance carrier may approve the application and provide coverage under the terms of the health plan, approve the application with specific limitations or exclusions or deny coverage altogether. Limitations and exclusions may be sought under the 12 month look back, 12 month exclusionary period which is provided to all health insurance carriers when determining coverage of pre-existing medical conditions. Elimination riders are also permitted to be incorporated into the health insurance policy. Elimination riders allow the health insurance carrier too temporarily or permanently exclude coverage for a specific medical condition. Under Mississippi law, health insurance carriers are not required to give credit for prior creditable coverage. There are no rate caps on individual health insurance premiums and the premium you are charged can be determined by age, gender, health status and geographical location of residence.

Mississippi (MS)
Small Group Health Insurance Regulations

Mississippi defines a small group as any company with 1 – 50 employees. Small group health insurance is issued on a guarantee issue basis for groups as small as one or as large as 50 employees. Under this premise, no group can be declined coverage or turned away due to their health status. It is a widely accepted practice for employers to require employees to endure a waiting period prior to be allowed to become eligible to join the employer sponsored health plan. Once the waiting period has been fulfilled, you will have become eligible to join the group health plan and need to complete an application for the health insurance carrier. The insurance carrier may then, or at some time in the future, exercise their right to a 6 month look back, 12 month exclusionary period on each applicant who does not have prior creditable coverage. The maximum exclusionary period for a pre-existing condition for an individual with no prior creditable coverage would be 12 months. Mississippi provides for group rates to be medically underwritten. Rating factors may, amongst other things, include geographic location, type of industry and number of plan members. Based on these factors and the overall health status of the group, insurance companies can modify the standard rate by 25%. Insurance companies must also offer guaranteed issue coverage to self-employed groups of one person.

Mississippi COBRA and Continuation Coverage

Mississippi does not have a state mini-COBRA regulation. Employers with more than 20 employees are regulated by federal COBRA laws. Federal COBRA laws provide that and employee may remain on the employer-sponsored health plan and eligible to receive the same level of coverage for a period of 18 months. The sole responsibility for payment of the entire premium lies with the employee. In addition, a 2% administration fee will be added to the monthly premium. For persons that have exhausted their COBRA benefits, or meet federal HIPAA guidelines, the Mississippi Comprehensive Health Insurance Risk Pool Association will provide guarantee issue coverage on an individual health plan.