When do individual health insurers have to sell me a policy?

In Alabama, your ability to buy individual health insurance may depend on your health status.

• In general, companies that sell individual health insurance in Alabama are free to turn you down because of your health status and other factors.  When applying for individual health insurance, you may be asked questions about health conditions you have now or had in the past.  Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers.
• Under Alabama law, newborns are automatically covered under your fully insured health insurance plan, if the plan covers dependents. Generally, the automatic period of coverage lasts for the first 31 days following the birth, however the length of this covered period may vary plan to plan. The insurer may require that the parent enroll the child within a certain number of days in order to continue coverage beyond the automatic period of coverage.

What will my individual health insurance policy cover?

• It depends on what you buy. Alabama does not require health insurers in the individual market to sell standardized policies. Insurers can design different policies and you will have to read and compare them carefully. However, Alabama does require all insurers to cover certain benefits - such as post-delivery hospital stays and breast cancer screening. Check with the Alabama Department of Insurance for more information about mandated benefits.

What about coverage for my pre-existing condition?

• Individual health insurers can impose elimination riders.  This is an amendment to your health insurance policy that permanently excludes coverage for a health condition or even an entire body part or system.
• Individual insurers can also impose pre-existing condition exclusion periods. In Alabama, an individual market insurer can apply a pre-existing condition exclusion period for up to 24 months.

  The definition of pre-existing condition is different under individual health insurance than under group health plans.  Individual health insurance can count as pre-existing any condition that was present within 5 years from the first day of coverage. In Alabama, pregnancy and non-cancer related genetic testing can count as a pre-existing condition.

• If you make a claim during the first two years of coverage, the insurer can look back to see if the claim is for a condition that would have been considered a pre-existing condition.  If the insurer determines that the condition is a pre-existing condition, it can refuse to pay for expenses for that condition.
• Unlike in the group market, you will not get credit towards your pre-existing condition exclusion period for any prior credible coverage you have between your old coverage and your new individual health insurance policy.

What can I be charged for an individual health insurance policy?

• Generally, in Alabama, there are no limits on how much individual premiums can vary due to age, gender, health status, family size, and other factors.
• When you renew your individual health insurance policy, your premiums can increase based on certain factors, such as your age.

Can my individual health insurance policy be cancelled?

• Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area.
• Some insurance companies sell temporary health insurance policies. Temporary policies are not guaranteed renewable.  They will only cover you for a limited time, such as 6 months.  If you want to renew coverage under a temporary policy after it expires, you will have to apply for a new contract. There is no guarantee that coverage will be re-issued at all or at the same price.