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

In Idaho, your ability to buy individual health insurance may depend on your health status. There are certain circumstances, however, when you must be allowed to buy individual health insurance.

• In general your access to individual health insurance may depend on your health status. Your application can be turned down based on your health status.
• If you are turned down by an individual health insurer because of your health status, you may be eligible to buy a High Risk Reinsurance Pool Plan (HRP) plan from that insurer (see below).
• If you have a disabled child, that child may remain covered under your individual health insurance policy after he or she reaches the age at which dependent coverage is usually terminated. To qualify, your adult son or daughter must be unmarried, incapable of self-support because of mental retardation or physical disability and must be chiefly dependent on you, the policyholder, for support. Proof of incapacity must be furnished to the insurer within 31 days of the date your child reaches the limiting age.

What will my individual health insurance policy cover?

• It depends on what you buy. In general, health insurers can design different policies and you will have to read and compare them carefully. However, Idaho does require all individual health insurance policies to cover certain benefits - such as mammograms. Check with the Idaho Department of Insurance for more information about mandated benefits.

• The Idaho Department of Insurance provides a list of health insurance companies that sell health insurance to individuals. The list is available on the web at http://www.doi.idaho.gov/health/healthinfo.aspx.

What about coverage for my pre-existing conditions?

• If you can buy an individual health insurance policy, there are limits on pre-existing condition exclusion periods that can be imposed. In general, if you have been uninsured for more than 63 days before your individual health insurance becomes effective, you may face a 12-month pre-existing condition exclusion period. The definition of pre-existing condition is different under individual health insurance than under group health plans. Individual health benefits can count as pre-existing any condition for which you received, or - in your insurer’s judgment for which you should have sought - a diagnosis, or medical advice or treatment in the 6-month period prior to the effective date of the individual health insurance policy. This is called the prudent person rule. You will get credit for prior continuous coverage that was not interrupted by a break of 63 or more days in a row.
• Individual health insurers can apply pre-existing condition exclusion periods for pregnancy, if you were pregnant on the effective date of coverage.

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

• In Idaho, your individual health insurance policy premiums can vary to reflect your health status, age, gender, individual tobacco use, family size, where you live, and the type of plan you seek.

• When you renew your individual coverage, your premiums can increase as your age increases.

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 a managed care plan’s service area. However, your health coverage may be canceled if the insurer does not continue to offer the coverage for all policyholders.
• 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 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.