When do health insurers have to sell me individual coverage?         

In Maryland, your ability to buy an individual health insurance policy may depend on your health status.

• Insurers that sell individual health insurance in Maryland 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 a policy or offer to sell you a policy that has special limitations on what it covers. If this happens, you can buy health insurance from the Maryland Health Insurance Plan (MHIP).
• Under Maryland law, newborns, adopted children, and children placed for adoption must be covered under your individual health insurance policy for the first 31 days following birth, adoption, or placement, if the plan 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.
• Under Maryland law, children who have been placed under your guardianship (other than a temporary guardianship of less than 12 months) must be covered under your individual health insurance policy for the first 31 days following placement, 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.
• Under Maryland law, dependent grandchildren may also be eligible for coverage under an individual health policy. If your grandchild was placed in your custody by court-order and your plan covers dependent, then your grandchild is eligible for coverage.
• Under Maryland law, your disabled child can remain covered as a dependent under your health plan into adulthood. This applies if your dependent was already disabled and covered under the health insurance policy before he or she reached the limiting age for dependent coverage. In addition, your disabled dependent must be unmarried. You will have to document that you provide support for your disabled dependent. If you subsequently change health insurance policies, you might not be able to cover your adult disabled dependent son or daughter as a dependent under the new health insurance policy.

What will my individual health policy cover?

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

What about coverage for my pre-existing condition?

• If you buy an individual health insurance policy from an HMO, you will not face a pre-existing exclusion period. HMO’s cannot impose pre-existing exclusion periods.
• If you buy a non-HMO individual health insurance policy, there might be an elimination rider on any medical condition that you currently have or had in the past. An elimination rider is an amendment to your health plan contract that temporarily or permanently excludes coverage for a health condition, body part, or body system.

In addition, if you make a claim during the first 24 months of the policy, the insurer can refuse that claim and others related to the condition if it determines the condition was present within 7 years of the time of application. Pre-existing conditions include those that were not previously diagnosed, but caused symptoms for which the plan determines a prudent person would have sought care.  This is the prudent person standard.   

Pregnancy can be considered a pre-existing condition in individual health insurance policies, but genetic information cannot. 

Finally, if a pre-existing condition does apply on your individual health insurance policy, you cannot reduce it by crediting prior continuous coverage. 

What can I be charged for individual health coverage?

• If you have an expensive health condition, your individual health insurance premiums may be very high. The law does not prohibit individual health insurers in Maryland from charging you more because of your health status.
• In addition, when you renew your individual health insurance policy, your premiums can increase substantially as you age.

Can my individual health Insurance policy be cancelled?

• Your health 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 HMOs, continue to live in the plan service area. Your health coverage may also be cancelled if the insurer or HMO discontinues your health policy or withdraws from the individual market.
• Some insurers sell temporary health insurance plans. Temporary policies are not guaranteed renewable. They will only cover you for a limited time, such as 6 months. If you want coverage under a temporary policy after it expires, you will have to apply for a new contract and there is no guarantee that coverage will be re-issued at all or at the same price.