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

In Mississippi, your ability to buy an individual health insurance policy depends on your health status. There are limited circumstances when you must be allowed to buy an individual health insurance policy.

In general, companies that sell individual health insurance in Mississippi 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 have trouble buying private health insurance due to your health status, you may be eligible for MCHIRPA (see page 19).

Under Mississippi law, newborns are automatically covered under the parents’ individual health insurance policy for the first 31 days, if the plan covers dependents. The insurer may require that the parent enroll the child (and pay the premium) within the 31 days in order to continue coverage beyond the 31 days.

If you have a disabled child, he or she may remain covered under your individual health insurance policy after reaching the age at which dependent coverage is usually terminated. To qualify, your adult son or daughter must be incapable of self-support because of mental retardation or physical disability and must be chiefly dependent on the policy holder for support. Proof of incapacity must be furnished within 31 days of reaching the limiting age and may be required periodically thereafter.

What will my individual health insurance policy cover?

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

What about coverage for my pre-existing condition?

Individual health insurance can impose elimination riders. 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. Elimination riders can be applied even if you have prior creditable coverage.

Mississippi insurers can also impose a pre-existing condition exclusion period. Pre-existing condition exclusion periods cannot exceed 12 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 for which you received care, or – in the insurance company’s judgment – for which you should have sought care. This is called the prudent person rule. Individual insurers may look back 12 months for signs of a pre-existing condition. In Mississippi, genetic information can count as a pre-existing condition, but pregnancy cannot.

Unlike group health plans, individual health insurers are not required to credit prior health coverage toward pre-existing condition exclusion periods.

If you make a claim during the first two years of coverage, the insurer can look back 12 months from the time of your applicant to see if the claim is for a condition that would have been considered a pre-existing condition. If the insurer determines, using the prudent person standard, that the condition is a pre-existing condition, it can refuse to pay for expenses for that condition.

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

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

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

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 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.