West Virginia Individual Health Insurance
Health insurance is an essential protection that allows you to have peace of mind, knowing that you and your family are financially protected against expensive medical needs. If you are currently uninsured, looking into a West Virginia individual health insurance policy is a smart choice. Since you are considering private health insurance, you may want to know more about the West Virginia laws regulating individual health insurance policies.
Eligibility: How Am I Evaluated?
West Virginia individual health insurance applications are reviewed based on factors determined by the insurer. There are no West Virginia laws that regulate how an application should be reviewed. Additionally, an applicant can be denied coverage for any reason, as there are no West Virginia regulations regarding who should or should not be granted coverage. However, HMO companies do have an annual open enrollment period in which plans are issued without regard to your health status.
In accordance with HIPPA Group-to-Individual Portability Coverage regulations, West Virginia guarantees issuance of health insurance via AccessWV, the state's high-risk health insurance pool, to HIPPA eligible consumers who have been unable to obtain a policy from a private provider.
West Virginia Guaranteed Benefits & Pre-Existing Conditions
For the most part, insurers are not required to include specific policies in their selection of plans. There are no laws in West Virginia that mandate standardized policies for individual health insurance. That being said, there are a few benefits that all insurers are required to cover under all plans, such as childhood immunizations.
In West Virginia, pre-existing conditions are handled in several ways:
- First, HIPPA-eligible consumers with guaranteed issue plans cannot have exclusionary periods imposed against them.
- Second, 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.
- Third, an insurer can impose an exclusionary period on suspected pre-existing conditions. They can look back into your medical history up to 2 years prior to your application date to find any pre-existing conditions. This exclusionary period can last up to 12 months.
- Additionally, 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 up to 2 years prior to your application date to see if it is something that should have been listed as a pre-existing condition. If so, then your claim can be denied. The insurer no longer reserves this right after 2 years.
- Lastly, insurers are not required to give you credit for prior health insurance coverage.
West Virginia Individual Health Insurance Premiums
Your West Virginia individual health insurance premiums can be determined based on a number of different individual factors and there are no limits on how higher your premiums can go because of these factors. Your premiums can also be increased when your policy is renewed, based on your insurers discretion.
In conclusion, premiums are based on internal rules and regulations of your insurer. There are no laws that regulate how much you can be charged for an individual health insurance policy in West Virginia. Luckily, health insurance plans in the state are guaranteed renewable, so your insurer cannot cancel your policy because you got sick. They may, however, raise your premiums to offset these costs.