When do individual health insurers have to sell me coverage?         

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

• In general, companies that sell individual health insurance in Nebraska are free to turn you down because of your health status and other factors. When applying for individual coverage, 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.
• In Nebraska, newborns are automatically covered under the parents’ individual health policy for the first 31 days. The insurer may require that the parent enroll the baby and pay the premium within the 31 days in order to continue coverage beyond the 31 days.
• In Nebraska, mentally retarded and physically disabled dependents are permitted to remain insured under their parents’ individual health insurance policy after they reach the age at which dependent coverage is usually terminated, if certain conditions are met. The adult dependent must be incapable of self-support and must rely on the policyholder for support. In addition, proof of dependency and disability must be provided to the insurer within 31 days of the dependent reaching the limiting age.

What will my individual health insurance cover?

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

What about coverage for my pre-existing condition?

• Individual health insurers can impose elimination riders. This is an amendment to your health insurance policy that permanently excludes coverage for a health condition or even an entire body part or system.
• Nebraska insurers can also impose pre-existing condition exclusion period. Except when you are HIPAA eligible, there are no limits on pre-existing condition exclusion periods in individual health insurance in Nebraska. This means that individual health insurers can decide how long to exclude your pre-existing condition.

Typically, a pre-existing condition is any condition for which you received, or - in your insurer’s judgment, for which you should have sought - a diagnosis, medical advice, or treatment prior to obtaining the individual policy.  This is called the prudent person rule.  In Nebraska, individual health insurers has broad discretion to define what constitutes a pre-existing condition, even including an undiagnosed condition you may unknowingly have had when you applied for the policy.  If you make a claim for a health condition after you buy a policy, it may be denied if the insurer decides the condition was pre-existing.  Individual health insurers can count pregnancy as a pre-existing condition, but not genetic information

What can I be charged for individual health coverage?

• In Nebraska, there are no limits on what you can be charged for individual health insurance. You can be charged substantially higher premiums because of your health status, age, gender, and other characteristics.

If you have questions about your premiums, contact the Nebraska Department of Insurance.

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, premiums can increase substantially as you age or if your health declines.
• Some insurance companies sell short-term health insurance policies. Short-term 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 short-term 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.