California health
insurance
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Apply online for health coverage
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Health underwriter and applicationHow does the health
underwriter fit into the enrollment process?
UPDATE: Health insurance is no longer
medically underwritten for ACA health plans
since 2014. You can
quote the
new ACA plans here.
The term "health underwriter" is thrown
around all the time but most new applicants are
not aware of what it means. "Underwriter" sounds
ominous but it is really just a person working
for a health insurance carrier that makes
decision on individual cases to either approve
(sometimes with a higher rate) or decline
coverage based on the underwriting guidelines
established by the company. Why do the carriers
even have underwriters to evaluate California
health applications?
Gray area and medical history
Individual health insurance in California is
medically underwritten. This means that you have
to qualify for coverage based on health. They
can decline or change premium rates based on
health. The carriers establish guidelines on how
to view given health conditions in terms of
their decision. The guidelines are primarily
based on claims history. For example, if height
and weight affect claims for health issues
covered by insurance plans (which it does
significantly), then going forward, height and
weight will be looked in terms of
"underwriting". The guidelines are helpful but
some issues or conditions can hard to gauge.
There are conditions that can be very serious or
quite benign.
This situation can be seen with the Tonik
simplified issue application. Tonik has a
simplified underwriting process. They will not
request medical records and they make a decision
solely based on the information on application.
If they are unable to make a decision based on
the information provided, they will not approve
the the policy. In fact, some of the application
are self-adjudicating which means that the
computer will automatically make a decision in
some cases where there is very little or no
health issues.
Underwriter's impact on the health insurance
decision
There are times when we have a declination
from one carrier and an approval from another
for the exact same applicant. This occurs even
though the underwriting guidelines can be very
similarly from carrier to carrier. Ultimately,
the underwriter is a person and must make a
final decision in gray area situations where the
condition can go either way. The underwriter
will look at all available information and try
to reach a decision that best matches the
carriers guidelines. In other words, there is a
level of subjective decision making in the
process. If a person is declined for coverage
from one carrier, we recommend that they apply
for coverage with another carrier for a
comparable plan. There is not fee to apply and
no downside to applying to more than one
carrier. In California, you have a 10 day free
look period from the time they come back with a
decision to say no for a full refund.
Other work provided by underwriters
The underwriter scans through the application
to make sure all the information is complete.
He/she will request any information missing from
the application and this can delay the
underwriting process so try to be thorough when
completing the application. The online
application helps to eliminate this problem as
it forces you to complete each section. The
underwriter also makes the decision to request
medical records from doctors or other providers
if additional is needed beyond what is needed on
the application. Once all needed information is
in (including medical records if requested), the
underwriter make a decision as to approval, at
what rate, or declination. The underwriter is an
important person in the individual health
insurance enrollment process.
You can run your
Covered
California Plan Quote here
to view rates and plans side by side from the major carriers...Free.
Again, there is absolutely no
cost to you for our services. Call 800-320-6269 Today!