When do individual health insurers have to sell me coverage?         

In North Dakota, 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, insurers that sell individual health insurance in North Dakota 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.
• If you have been denied coverage because of your health status, you can buy individual health insurance from CHAND.
• If you are HIPAA eligible, you can buy individual health insurance from CHAND. You will not have a pre-existing condition exclusion period. There are limits on what you can be charged.
• In North Dakota, newborns, adopted children and children placed for adoption are automatically covered under the parents’ fully insured health plan for the first 31 days. The insurer may require that the parent enroll the dependent within the 31 days in order to continue coverage beyond the 31 days.
• If you have a disabled child, that child may remain covered under your health plan after he or she reaches 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 policyholder for support. Proof of incapacity must be furnished to the insurer within 31 days of reaching the limiting age and may be required subsequently in the future.

What will my individual health insurance cover?

• If an insurance company offers you individual health insurance, it must offer you a basic and standard health plan. These are standardized plans with benefits identical to those under group health plans. Standardized plans help you compare the cost of policies. You may be offered non-standardized plans as well.

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. Insurers cannot impose elimination riders on basic and standard health benefit plans.
• North Dakota insurers can also impose pre-existing condition exclusion period. Pre-existing condition exclusion periods cannot exceed 12 months. If a 12-month exclusion period is applied, you can get credit for any prior continuous creditable coverage you have had as long as you have not had a gap of 63 days or more between your old and new coverage.

The definition of pre-existing condition is the same under individual health insurance and group health plans.  Individual health insurance can count as pre-existing conditions only those for which you actually received (or were recommended to receive) a diagnosis, medical advice, or treatment in the six months prior to obtaining the individual health policy.  Individual health insurers can count pregnancy as a pre-existing condition, but not genetic information

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 North Dakota health insurers from charging you more because of your health status.

Can my individual health insurance policy be cancelled?

• If you have an individual plan, 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 within limits as you age.
• 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.