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high-risk health insurance
Old 12-03-2011, 02:48 PM   #1
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high-risk health insurance

I'm not at all clear what health conditions make a person "uninsurable". If things turn out such that law will not require insurers to cover everyone, what are typical situations that will cause insurers to run and hide? Is it standard that pre-existing conditions cannot be insured at all, or do certain high-deductible plans cover them? Along with better understanding what a high-risk person is likely to face insurance-wise, I'd like to get a handle on what the premiums might be. Thanks in advance for sharing experience and advice.
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Old 12-03-2011, 03:05 PM   #2
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Old 12-03-2011, 05:47 PM   #3
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It also varies from carrier to carrier. I had BCBS offer me a high deductible (10G) HSA policy that had a lifetime exclusion for anything headache related. I kindly declined.

I bought a policy through Golden Rule and they didn't have a problem with my migraines. Go figure.
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Old 12-03-2011, 06:53 PM   #4
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I applied with several companies with the help of an insurance broker in 2000. Every carrier was different. I had one offer that excluded forever my known conditions, but also excluded "any tumor" even though I had never had cancer or any evidence of it. And then when I did get a high-deductible private policy that only excluded my known problems, a year later the company pulled out of my State entirely and I had to start from square 1 again.
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Old 12-04-2011, 07:25 AM   #5
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Originally Posted by GrayHare View Post
I'm not at all clear what health conditions make a person "uninsurable". If things turn out such that law will not require insurers to cover everyone, what are typical situations that will cause insurers to run and hide? Is it standard that pre-existing conditions cannot be insured at all, or do certain high-deductible plans cover them? Along with better understanding what a high-risk person is likely to face insurance-wise, I'd like to get a handle on what the premiums might be. Thanks in advance for sharing experience and advice.
This is not easy. You need to see your state regulations. This web site can help Kaiser State Health Facts.

Insurance companies will deny you a policy if you have a pre-existing condition (had cancer or heart attack, have rheumatoid arthritis, diabetes or asthma) or because their underwriters feel your health is not adequate to insure. Your state may have a high risk pool and it may be open still for enrollment. There is a federal PCIP that guarantees coverage, Pre-Existing Condition Insurance Plan (PCIP) | HealthCare.gov One important drawback is that eligibility requirements include having been uninsured for at least 6 months.
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Old 12-04-2011, 08:30 AM   #6
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It is state specific. I can only comment about California. Here the state regulations prohibit exclusions for over 6 months , so all of the carriers either accept you or decline. Usually they decline.
They can set a very high rate surcharge for someone , overweight , smoker ,etc, as long as the surcharge is applied to everyone in that policy line equally . You can only be canceled for lapse of payment, fraud , or the carrier discontuning that specific line of policy.You cannot be canceled or have your rate raised because of claims.

The application will ask about any injury , illness, disease that you have received treatment for, sought treatment for, or even had a health professional advised you to seek treatment for,or should have sought treatment for, during the last ten years. The insurrance co. wants to cover their a$$ on everything!

The way it is in CA, Anyone over 25 is declined unless in super good health , with almost no illness needing treatment or meds for the prev. 10 years. Ya, it sucks.

If you have group coverage, C.O.B.R.A. , then conversion is how most get coverage when leaving the group.

The state runs a high risk pool , very high rates, crapy coverage, limited term, ( 2 years max I think), and the max cap on benefits is $80k I think. To qualify, you must prove 2 declines, and no coverage for 6 mo.

Do a search on this site if you have not already done so. You will find dozens of threads on the subject.

The Healthcare Reform act will change the pre-existing exclusions , but except for children, that part does not kick in till 2014.
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Old 12-04-2011, 10:35 AM   #7
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If you have group coverage, C.O.B.R.A. , then conversion is how most get coverage when leaving the group.
Thanks for the replies.

About conversion... if a health condition developed while under a group plan or COBRA, does that mean upon moving to an individual retiree health plan, that condition will be covered via conversion?
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Old 12-04-2011, 11:18 AM   #8
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Thanks for the replies.

About conversion... if a health condition developed while under a group plan or COBRA, does that mean upon moving to an individual retiree health plan, that condition will be covered via conversion?
It would depend on the specific contract your group plan has with the insurer , and the state you live in. Get with your H.R. dept to see the plan contract , unless you need to keep quiet about your early retirement.

I have the luck that my employer , "Mega-City", has a guarantee issue conversion clause when cobra is exhausted, for employees who leave before being covered by subsidized retiree health plan.

Those in CA in a group plan without such a feature have to apply for coverage with any insurer within a specified time of cobra benefit exhaustion , and then if denied coverage, can get a guaranteed issue plan with no exclusions. Such "Guarantee Issue" individual plans are quite costly. Dave Fluker Insurance has current carrier rates in CA. see link http://www.davefluker.com/hipaa.html

My opinion is the guarantee issue w/o exclusions part of Healthcare Reform will survive several court challanges , but it may be quite costly , as I also think the " Must Buy " part of the so-called "Obama Care" will be thrown out in court.
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Old 12-04-2011, 11:58 AM   #9
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Thanks for the replies.

About conversion... if a health condition developed while under a group plan or COBRA, does that mean upon moving to an individual retiree health plan, that condition will be covered via conversion?
For that you need to look at the conversion options offered by the health care insurance provider that covers your group plan and COBRA. Insurance policies cannot exclude pre-existing conditions under new policies when there has been continuous coverage in place for more than 12 months. Whether the conversion policies are guaranteed, and rates, are determined by individual state regulation.
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