Individual Health Insurance Sold by Private Insurers

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When do Individual Health Insurers have to sell me a policy?

In New Hampshire, your ability to buy individual health insurance depends on your health status.  There are certain circumstances, however, when you must be allowed to buy an individual health insurance policy.

  • In general, insurers that sell individual health insurance in New Hampshire are free to turn you down because of your health status and other factors. When applying for individual health insurance, 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 you are HIPAA eligible, you are not guaranteed the right to buy individual health insurance from private insurers. However, you are guaranteed health insurance coverage from the New Hampshire Health Insurance Plan.
  • In New Hampshire, newborns, adopted children, and dependent grandchildren are automatically covered under the parents’ individual health insurance for the first 31 days, if the policy otherwise provides coverage for dependents. The health insurer may require that the parent enroll the child within the 31 days in order to continue coverage beyond the 31 days.
  • In New Hampshire, adult dependents with physical disabilities or mental retardation are able to stay on their parents’ individual health insurance policy after they have reached the age at which the policy 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. The health insurer may require that you show it proof of incapacity again in the future within 31 days of the expiration of dependent coverage.

What will my individual health insurance policy cover?

  • It depends on what you buy. New Hampshire does not require health insurers and HMOs in the individual market to sell standardized health plans. Health insurers and HMOs can design different plans and you will have to read and compare them carefully. Health insurers are required to provide you with written descriptions of their products so that you can compare the differences. New Hampshire does require all individual health policies to cover certain benefits - such as coverage for diabetes services and supplies and autologous bone marrow transplants. Check with the New Hampshire Department of Insurance for more information about mandated benefits.

What about coverage for my pre-existing condition?

  • There are different ways insurers are allowed, at the time you purchase an individual health insurance policy, to exclude coverage for your pre-existing conditions.

The insurer can impose an elimination rider for some conditions.  An elimination rider is an amendment to your health insurance contract that permanently excludes coverage for a health condition, body part, or body system. 

Also, an insurer may impose a pre-existing condition exclusion period.  Pre-existing condition exclusion periods cannot exceed 9 months. In addition, any pre-existing condition exclusion period that is applied to your individual health insurance policy must be reduced by any continuous creditable coverage. The same types of coverage that are available in group health plans are also considered creditable for individual health insurance.  Coverage counts as continuous if it is not interrupted by a break of 63 or more days in a row. 

When determining if a condition is pre-existing, an individual health insurer is allowed to look back 3 months to see if you actually received medical advice, diagnosis, or treatment for a condition.  This is called the objective standard. 

  • Pregnancy can be counted as a pre-existing condition by individual insurers. However, genetic information cannot be used as a basis for a pre-existing condition.

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

  • There are limits on how you can be charged for individual health insurance because of your health status, age, and tobacco use. Even within these limits, your premiums can be very high if you have a serious health condition.

In addition, when you renew your individual health insurance policy, your premiums can increase substantially as you age or if your health declines.

Can my individual health insurance policy be canceled?

  • Your individual health insurance 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 HMO plans, continue to live in the plan service area. Your health insurance policy may also be canceled if the insurer or HMO discontinues your health insurance policy or withdraws from the individual market.
  • Some insurers sell short-term health plans. Short-term policies are not guaranteed renewable. They will only cover you for a limited time, such as 12 months or less. If you want to renew coverage under a short-term health policy after it expires, you will have to reapply and there is no guarantee that the health insurer will be-reissued at the same price or at all.

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