OK, so now you've completed you homework to research, compare and apply for an individual health insurance plan. You think that the worst is behind you and that your plan will start very soon. Be aware that the process is just beginning for the insurance company, and in some cases it may take several months to get it processed and approved. There are a few things that you can do to help it along.
Underwriting
It is becoming more common that you may receive or be requested to make a phone call to the underwriting department to verify the information on your application. If they cannot contact you, this will delay underwriting your application. Please return their call ASAP. It is also very important that you only answer the questions asked, and do not give your opinion of the condition, or any additional information not specifically asked for. Let your medical records speak for your health conditions, your treatment, and any diagnosis you may have. Always remember, that it is the underwriter's job to screen out risk. They're looking for a reason to deny your application. Be careful of all statements that you make to them.
In some rare cases a physical exam is needed for underwriting. This often occurs when an applicant has not seen their doctor in over 5 years, is over 50 years old, or has a medication they're taking (or suppose to be taking, but are not) without a doctor's records to accompany it. Schedule any required Physical Exams as soon as possible. Many times the insurance company will want a paramed examiner to come to your home at no cost to you. The longer you wait to schedule it, the longer it takes to get the policy underwritten, issued and in effect.
If it is taking an extra long time to get your Medical Records, you may be asked to assist with getting them. This simply means that you should call your doctor's office right away and ask the records department if they could get the records to the insurance company ASAP. Many offices will have an outside records copying service that does this for them once a week.
Policy Issuance
Your policy may be issued in a few different manners:
Standard- This means your policy was issued as it was applied for. The coverage and rate remain the same.
Rated- Due to your specific health, an increase in premium was placed on the policy to cover the additional risk factors. This is normally about 10% for each medical condition. Some more advanced medical conditions can have rate-ups at 50-100%. Your health condition will now be covered under this plan just as any other medical condition would have been.
Exclusion/ Waiver- Due to health risk a condition may be completely excluded from coverage or may be temporarily excluded; generally 6 or 12 months. This means that no claims for this condition will be paid, or applied to your plan deductible for this period of time.
Separate Deductible included- Due to health risk a particular condition they may be willing to cover it, but only after a separate deductible is paid for claims on that individual condition. This deductible is separate from you plan deductible.
Declined- In this situation coverage was unable to be offered. The insurance company was not willing to do any of the above factors. Get together with your agent to discuss other options that may be available.
If you have ANY questions on what any of the above provisions means to you or your coverage please contact your insurance agent for clarification. You will only have a short time (normally 10 days) to accept or decline the changes.
Many insurance companies are now requiring that you sign a form outlining the changes that they have made to your policy coverages and rates, accepting them before your policy can go into effect. Understand how much more it will cost you, what you're NOT covered for, and for how long before you accept any policy.
Claims
Process All Claims! Let the insurance company decide what they will cover; don't guess. This will also help to ensure that you are having applicable items claimed applied towards your chosen deductibles. You may have more than one deductible to satisfy for different coverages. Some plans will have a separate deductible for prescriptions, inpatient hospitalizations, labwork, and outpatient surgeries. Submitting all claims may also help to reduce the charges you may be sent, because they negotiate the bills. Network discounts can be 20-90% depending on the provider, the location, and the service rendered. And don't forget, you can negotiate, or pay over time any bills that you receive.
I have also written many other articles on similar, and related topics that may answer other questions that you may have had.
Scott Rowen is an accomplished insurance professional with 18 years business insurance experience. He has MBAs in Business Insurance and Finance, and is a highly requested speaker at many professional venues across the US. He's currently the CFO of a very successful, award winning errors and omissions insurance company. http://www.EandOInsuranceofAmerica.com
