South Carolina Individual Health Insurance
Health insurance is an essential protection that allows your family to take care of basic medical needs without financial worry. If you are without group health insurance coverage, purchasing a South Carolina individual health insurance plan is a great option. Since you are considering private health insurance, you may want to know more about the South Carolina laws regulating individual health insurance policies.
Eligibility: How Am I Evaluated?
Private health insurance applicants in South Carolina are generally reviewed based on individual factors, such as age, health, and lifestyle choices. Insurers are free to look at any and all of these factors to determine if you would be a good customer. There are no regulations is South Carolina's insurance law that mandate who should and should not receive individual health insurance from private insurers. This means that insurers have the flexibility to accept or deny applicants for any reason, including health status and age.
In order to comply with HIPPA Group-to-Individual Portability Coverage regulations, South Carolina offers guaranteed acceptance into the South Carolina Health Insurance Pool for HIPPA eligible consumers who have had trouble securing an individual policy from a private insurer.
South Carolina Guaranteed Benefits & Pre-Existing Conditions
For the most part, your South Carolina individual health insurance policy will cover benefits depending on what type of plan you choose. Insurers in South Carolina are not required to carry any standardized policies and can decide which plans and benefits to offer to South Carolina residents. However, there are a few benefits that must be offered to all residents who purchase an insurance plan, including mammograms and diabetes treatment.
In South Carolina, pre-existing conditions are handled in several ways:
- First, the insurer can impose an elimination rider on any condition that it feels is pre-existing. This rider will exclude the condition(s) from your policy permanently.
- Second, an insurer can impose an exclusionary period on suspected pre-existing conditions. For HMOs this period can last up to 12 months. For non-HMOs, this period can last up to 24 months.
- Third, if you file a claim regarding a specific condition within the first two years of your policy, your insurer can look back in your medical history to see if it is something that should have been listed as a pre-existing condition due to your symptoms. If so, then your claim can be denied. The insurer no longer reserves this right after 2 years.
South Carolina Individual Health Insurance Premiums
Your South Carolina individual health insurance premiums will be determined by the insurer, according to their rules and regulations. There are no South Carolina laws that limit what you can be charged for a policy or that prevent an insurer from charging you more due to age health status, lifestyle choices, or any other reason. Most companies take these reasons, plus your plan type and family size, to determine what your rate should be.
The good news? Your health insurance will be guaranteed renewable no matter what happens with your health down the line. Your insurer cannot cancel your policy due to health status, age, or any other individual factor, even at renewal. On the other hand, they can raise your premiums to cover these increased risk factors, so you need to be aware of that as well and prepare for these increased costs.