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The Reader’s Question

I heard about health insurance rating from a colleague, and I would like to know more about it. Can you please clarify about it? Thanks.

Michael Smith

Thank you for this question.

The health insurance ratings of policies vary depending on the state and the type of policy. Policies of individuals are rated depending on the guidelines of the state as seen by the Department of Insurance of each state. The individuals have much more challenges to get more coverage than ever. Health insurers will be able rule out the conditions or even totally reject the coverage to individuals with such prohibitive risks. Due to this, individuals trying to get a coverage should not withdraw a group policy until a written confirmation is already received on the approval of the individual policy.

There are many different states that have high risk pools that permit the individuals who may not be able to get coverage via the high risk pool. In such states where there is no high risk pool the situation is harder to obtain policy coverage. Health insurance writing or the underwriting will permit the health insurer to reject such coverage. Consequently, individuals experiencing a serious health condition will not be permitted from getting any insurance coverage and may possibly divert to the public open enrolment through a health insurer just to get coverage. But this procedure is expensive. The policies for such public open enrolment may cover over a thousand dollars per month for a single coverage and three thousand dollars per month for the family coverage.

The employers’ health insurance is rated in a different way than that of individual policies. In accordance with the HIPAA or the Health Insurance Portability and Accountability Act and even the state laws, the employers who have just enough number of participating employees and who make a payment for the health coverage should be guaranteed coverage. These laws are applicable for the employers between 2 and 50 employees. The prices of the coverage vary a lot and the employer with no health conditions at all will get coverage much cheaper than an employer with a more serious list of health conditions.

The health insurance ratings are a complicated situation with discrepancies occurring by the state and coverage type one is looking for. All the information about individuals or employers is available in their respective state. In addition, they should visit the Department of Insurance website to start of their information quest. Normally these websites give out the necessary information to be able to learn the basics of what the laws of the state is involved in. Further, all individuals with coverage are listed with general information about getting coverage. Health insurance is such a complicated industry with such differences between all the 50 states of USA. With HIPAA, it defends consumers when it comes to such rating practices by health insurers. If you have an existing coverage and wants to get another policy and is accepted, the health insurers may not impose a condition limitation that is pre-existing as long as no gap in coverage of 63 days happened yet. So take note of the rules in policy cancellation until you have proof of coverage from your new policy.

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