When do individual health insurers have to sell me an individual health insurance policy?

In Alaska, your ability to buy an individual health insurance policy from a private insurance company depends on your health status. 

• In general, companies that sell individual health insurance in Alaska are free to turn you down because of your health status and other factors. When applying for an individual health insurance policy, 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 they offer to sell you a policy that has special limitations on what it covers. If you are turned down or offered a policy with reductions or restrictions, you may be eligible for ACHIA coverage. (See page 19.)
• Under Alaska law, newborns, adopted children, and children placed for adoption are automatically covered under the parents’ individual health insurance policy for the first 31 days, if the policy covers dependents. The insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days. Similarly, if the policy covers dependents, new spouses can be covered beginning on the 1st day of the 1st month after the date the health plan receives the enrollment request. The insurer may require that the enrollment request be received within 31 days of the date of marriage in order for coverage to be effective.

What will my individual health insurance policy cover?

• It depends on what you buy. Alaska does not require health insurers in the individual market to sell standardized policies. Health plans can design different policies and you will have to read and compare them carefully. However, Alaska does require all health plans to cover certain benefits - such as mammograms and prostate cancer screening. Check with the Alaska Division of Insurance for more information about mandated benefits.

What about coverage for my pre-existing condition?

• In Alaska there are different ways an individual health insurer can exclude a pre-existing condition. The insurer can impose an elimination rider. An elimination rider is an amendment to your health insurance contract that temporarily or permanently excludes coverage for a health condition, body part, or body system.

Also, an individual health insurer may impose a pre-existing condition exclusion period. There is no standard definition of pre-existing condition for the individual market under Alaska law; however, typically, a health plan will define a pre-existing condition exclusion to include both conditions that you actually received care for, as well as conditions or symptoms for which the insurer believes most people in your situation would have sought care.  This is called the prudent person rule.  Further, individual health insurers are not required to credit prior health coverage toward pre-existing condition exclusion periods.

In Alaska, pregnancy can be considered a pre-existing condition by individual health insurers. In addition, genetic information cannot be considered a pre-existing condition in the absence of a diagnosis. 

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

• If you have an expensive health condition, your individual health insurance premiums may be very high. The law does not prohibit Alaska health insurers from charging you more because of your health status.

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. However, guaranteed renewability does not protect you from having your premiums go up at renewal, and premiums can also increase within limits as you age or your health declines.
• 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 reapply and there is no guarantee that coverage will be re-issued at all or at the same price.