Individual and Family medical insurance is different from Group (Company) insurance in that they can decline and or change rates based on your medical at the time of application.
Below we have some common reasons for difficulties in getting approved but first a few quick tips regarding qualifying for coverage.
Some health issues and
reasons for declination are
time sensitive. This means
that we may be able to
qualify at a later time with
more time from when a health
issue is sign, symptom, and
treatment free. For very
basic situations, we
generally need 3-6 months
away. More involved
situations might require
12-18 months and serious
issues such as certain kinds
of cancer can require years
away.
There are multiple carriers
on the California health
market and although their
underwriting guidelines are
similar, they do fluctuate.
This means that we may get a
declination from one carrier
and an approval from
another. Based on experience
(2 decades now), it appears
that if claims spike,
underwriting tightens so
there can be applicants
where we expect a decline
but get an approval and vice
versa. For questionable
health situations, it makes
sense to apply to two
carriers at the same time
since you have a 10 day free
look window when they come
back with a decision. This
makes sense when time is
critical (such as being in
the Cobra election period).
Let's look at medication costs which can definitely affect our ability to qualify for coverage. First, a newer prescription can be more concerning. If you have been on a prescription for a longer period of time (let's say 6+ months), the carriers can then evaluate your application based on monthly cost. This is how carriers will look at maintenance medications (for example, cholesterol or blood pressure). What is the monthly cost? Brand name medications obviously affect this analysis quite a bit since they are much more expensive. A generic equivalent will weigh less heavy on the underwriting decision. Keep in mind that a sudden switch to generic (or plan to) will not help us qualify since it falls under the "newer prescription" issue above.
A Cobra option can affect what we want to do regardless of underwriting. Cobra is generally very expensive but it's guaranteed issue (regardless of health). We just want to make sure we don't lapse our Cobra election option or monthly payment while applying for individual health insurance. We have written an entire article on the Cobra versus Individual
California health insurance
option.
California health carriers
can offer split decisions.
They may approve one family
member and decline another.
There's an "all or none"
question on the application
which we recommend not
checking. It's best to let
the carriers underwrite
individually for family
members and see what they
come back with.
Carriers are generally
looking at recent or more
serious health history
situations. We all have
health issues and yet 80% of
applications get approved so
it's best to apply and see
what the come back with.
Children will be guaranteed
issue now anyway.
If you have not had coverage
for the last 6 months, you
may be eligible for the PCIP
plan. We still need a
declination to qualify so we
want to apply for standard
coverage (ideally our
preferred plan) either way.
If you have questions about your preexisting conditions whether listed above or not, please call us at 800/320-6269 or email us to receive personal assistance from a licensed California medical agent. We will be able to advise you based on your specific medical history.
Call us at 800-320-6269 with any questions. Our services are free to you as licensed health agents.