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

In Arkansas, your ability to buy an individual health insurance policy depends on your health status. 

• In general, companies that sell individual health insurance in Arkansas 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 offer to sell you a policy that has special limitations on what it covers.
• If you are turned down by an individual health insurer, you may be able to buy a policy from CHIP.
• Under Arkansas law, newborns and adopted children must be automatically covered under the parents’ individual health policy, if the plan covers dependents. If you have a newborn, the insurer may require that you notify it of the child’s birth within 90 days or before the next payment is due, whichever date is later. If you plan to adopt a child, coverage begins when you file to adopt the child, but you have to notify the insurer about the filing within 60 days. If you are adopting a newborn and you notify the insurer within 60 days of filing, the start of coverage will be backdated to the day the child was born.
• Under Arkansas law, adult dependents who are physically disabled or mentally retarded are, at the option of the insured, able to stay on their parents’ individual health insurance policy after they have reached the age at which the plan usually cancels dependent coverage. In order to be eligible, the adult dependent must be incapable of self-support and must be dependent on the policyholder for support. Proof of incapacity must be provided to the insurer within 31 days of reaching the limiting age.

What will my individual health insurance policy cover?

• It depends on what you buy. Arkansas 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, Arkansas does require all health plans to cover certain benefits - such as post-delivery hospital stays and breast reconstruction following mastectomies. Check with the Arkansas Insurance Department for more information about mandated benefits.

What about coverage for my pre-existing condition?

• Generally, there are no limits on how long individual health insurers in Arkansas can exclude coverage for your pre-existing conditions. You may also be offered coverage that contains a permanent exclusion on a health condition, body part, or body system. Permanent exclusions are known as elimination riders.

Also, an individual health insurer may impose a pre-existing condition exclusion period.  A pre-existing condition is a condition for which, in the 5 years, you received care, or - in the insurance company’s judgment - for which you should have sought care.   This is called the prudent person rule.  Generally, provided the individual health insurer asks you about your medical history, there is no limit on how long the insurer may apply a pre-existing condition exclusion period. However, individual health insurers that do not ask about your pre-existing conditions when you apply for coverage can only exclude your pre-existing conditions for 12 months. Finally, individual health insurers do not have to give you credit for your prior coverage.

In Arkansas, pregnancy can be considered a pre-existing condition in individual health insurance.

• Individual health insurers can exclude from coverage certain health conditions or conditions affecting certain body parts for only 6 months. These conditions and body parts are: hernia, disorder of reproductive organs, varicose veins, adenoids, appendix, and tonsils.

What can I be charged for individual health insurance policy?

• Generally, in Arkansas, there are no limits on how much individual premiums can vary due to age, gender, health status, family size, and other factors.

Can my individual health insurance policy be canceled?

• 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 six months. If you want to renew coverage under a temporary policy expires, you will have to reapply and there is no guarantee that coverage will be re-issued at all or at the same price.