CALIFORNIA MEDICAL
Underwriting

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CALIFORNIA INDIVIDUAL HEALTH INSURANCE UNDERWRITING

If your Employer does not offer your Employer Sponsored Group Health Insurance or you are self employed, between jobs, or just plan lacking health insurance you can apply for an individual and family health insurance policy.  Before you give up your alternative options, be aware that individual health insurance plans are medically underwritten, meaning the insurance carrier will review the medical history of you and your family members and can possibly assign you are rate increase or even decline to cover you entirely for insurance if the medical conditions warrant.

DOES INSURANCE COMPANIES USE THE SAME CRITERIA TO APPROVE OR DECLINE APPLICANTS?

No, each insurance carrier has their own set of underwriting guidelines it uses to determine rates a eligibility.  If you are declined or rated up on premiums at one insurance carrier it does not necessarily mean you will be declined at another one.  The insurance carriers do submit non published guides to the department of insurance so you can get an understanding of what may happen when you submit an application per health condition.  For example, the following health conditions may result in an automatic decline for coverage:  AIDS, type 1 diabetes, untreated diabetes, lung cancer, pancreatic cancer, strokes, & heart disease.  The following types of health conditions may result in an approval for coverage, but with a rate increase assigned:  mildly unfavorable height to weight ratio, treated type 2 diabetes with no other health issues, minor blood pressure or cholesterol levels which are treated.

CAN SMOKING OR DRINKING CAUSE THE INSURANCE CARRIERS TO CHARGE MORE?

Yes, the insurance companies can consider smoking and drinking when reviewing medical history.

WHAT IF IíM OVERWEIGHT?  DO THE INSURANCE CARRIERS USE BODY MASS INDEX TO DETERMINE ELIGIBILITY? 

Yes, typically the insurance carriers will use body mass index (BMI) as a means to determine rate eligibility.  Any BMI under 39 is typically reviewable by an underwriter but still potentially declinable if there are other minor health issues and the BMI is over the number 30.

WHAT ABOUT MENTAL HEALTH ISSUES?

If youíve had just some simple routine counseling without medication and it happens to be situational you can potentially get an approval at best possible premium rate.  Mild depression or situational depression can result in standard or increased rates.  Chronic depression or severe mental illness is considered to be very serious an can result in a decline for coverage. 

Whatever your situation is contact us for help with questions.  We are always happy to answer any questions you may have about current or prior health situations.  Letís face it, weíve all been to the doctor before.  If you would like to see some standard pricing for individual health insurance plans click here.  If you need an employer sponsored small group California health insurance quote click here.

Make sure you do not cancel any existing coverage in place while applying for a new plan.  Remember, you can always move your effective date of coverage on your new plan typically one time.

 


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