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Individual Health Underwriting
Once you've decided to purchase individual health insurance, it's natural to want coverage as soon as possible.
If you're healthy, do not take prescriptions, and have no medical conditions in your history, the process can be quite rapid, especially if you apply online.
Most applicants have had some medical problems, take medication, or have a chronic condition. In these cases, medical underwriting can take as long as 4-6 weeks.
Here are some tips to ensure the underwriting process goes as quickly as possible:
- Completing the application
- Underwriting flags
- Medical records release
- Rating tiers and levels
- Guaranteed issue coverage
- Changing coverage
Completing the application
Applications for health insurance must be complete and accurate.
We work with Blue Shield of California and Anthem Blue Cross of California for individual health. Both accept online or paper applications:
| Anthem Blue Cross | Blue Shield of California |
|---|---|
| apply online Anthem | apply online BS |
| pdf Anthem application | pdf BS application |
- Honest and complete answers to questions about medical history are required (note the time frame listed on the application)
- Do not omit requested information-this is insurance fraud
- Complete additional pages if necessary
Underwriting flags
Carriers are fairly strict in their underwriting for individual policies. Some conditions automatically trigger medical records review and others are automatic declines. The more conditions present, the less likely is approval. Young healthy people are often approved without a lengthy review.
Example conditions for medical review
- Allergies
- Asthma
- Fractures
- Headaches
- Hypertension
- Sinusitis
- Ulcers
Example Automatic Decline conditions
- Recent surgery, still in treatment
- Mental health issues, in counseling, on medication
- Pre-existing conditions such as recent cancerous cells
- Chronic conditions with ongoing treatment
Both carriers offer an anonymous underwriting prescreen for prospective members. Request a probable action underwriting screening.
Medical records release
Long delays can occur if medical records are not received in a reasonable time. You can help by calling your health care provider to ensure records are sent. Keep a record of when providers were contacted, in case follow-up is necessary. Medical offices are busy. Be persistent!
Rating regions, tiers and levels
Individual health coverage is priced by age, gender (a new trend), location of residence, number of family members covered, and medical history.
Some newer plans are only available as single-coverage, requiring each family member to be rated separately. Once approved, a carrier cannot change your rating tier or level to a more expensive one, but if you are healthy over a period of time you can request a medical review to lower your rate.
Carriers raise rates as a class, usually once a year, but they can do so more often. At initial enrollment, you have a twelve month rate-guarantee.
Guaranteed issue coverage
If you do not medically qualify for individual coverage, but meet other requirements, you may be eligible for guaranteed issue coverage.
You must have exhausted available COBRA (and/or Cal-COBRA) coverage and not lapsed coverage. Guaranteed issue plans under the Health Insurance Portability and Accountability Act (HIPAA) are more expensive and a very limited choice of plans are available.
Contact us for more information.
Changing coverage
As premiums rise, you may wish to consider plans with lower premiums.
Depending on your current plan and the length of time you have had coverage, you may be able to transfer without a medical review. Contact us for information on your best options.
For Anthem Blue Cross plans, you can visit www.changemycoverage.com to compare other plans with your current coverage.