We often get calls from people with pre-existing medical conditions who are concerned that a California health insurance company will decline to offer them insurance.
This is a legitimate concern. We estimate that California medical insurance companies decline about one-out-of-four or one-out-of-five people who apply for health insurance coverage. (Note: this is our unscientific estimate - please do not accept this as anything more than an educated guess as to the number of people whom the companies decline to offer coverage.)
If you have a pre-existing medical condition and want to apply for health insurance here is some advice:
- Tell the truth on the application - with health insurance you are buying the security of knowing that your medical claims will be paid if you get sick or injured. If someone lies on an application, the insurance company can - and does - refuse to pay medical insurance claims and refunds any premium. Accordingly, if you lie and do not disclose a pre-existing medical condition you are hurting yourself and you are also violating the law. So, tell the truth.
- Consider applying for temporary health insurance at the same time as you apply for permanent medical insurance coverage. There are fewer questions to answer on temporary health insurance applications and it seems to be easier to qualify for temporary health insurance. If a company has ever declined your application for coverage you will not qualify for temporary coverage. So, if you're concerned about being rejected and you apply for temporary coverage at the same time as permanent coverage, you can honestly say that you have never been declined (if that is the case.) Remember that temporary coverage does not count for HIPPA guarantee issue and could cause you to loose your eligibility for a guarantee issue HIPAA policy. Only enroll on a temporary policy if you are not eligible for COBRA or HIPAA. A person can keep Blue Shield of California's Option 12 temporary insurance for up to 12 months. So, temporary can be up to a year.
- Consider applying to more than one health insurance company at the same time. Many of the insurance companies ask if you have ever been declined for coverage. Using the same logic as above when applying for temporary coverage, if you can honestly say that an insurance company has never rejected your application, you may want to submit applications to different insurance companies. All of the companies have different criteria (i.e., underwriting guidelines.) We have seen some people approved by one company and rejected by another.
Also, remember that if a California health insurance company denies your application and COBRA or HIPAA are not options, you can apply to the State of California's Major Risk Medical Insurance Program (http://www.mrmib.ca.gov.) This government plan accepts people with pre-existing medical conditions. Blue Cross, Blue Shield and Kaiser are some of the companies which participate in this program.
The down side of MRMIP is that it is expensive, has limited benefits and excludes treatment for pre-existing medical conditions for a certain amount of time.