Individual health insurance is insurance you buy on your own, rather than having it provided by your employer. Please examine your options carefully before declining group coverage or continuation coverage, such as COBRA, that may be available to you. You should be aware that companies selling individual health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage entirely.
that could result in a higher premium or you could be denied coverage entirely.
If you are in the market for individual health insurance, most insurance companies have online tools to help you find out how much individual health insurance will cost. If you have a chronic illness or other health condition, it can be hard to buy individual health insurance. If you have applied for individual health insurance and been denied, the information below may help you determine why you may have been denied and if that denial was appropriate.
The following summarizes underwriting information that health insurance
companies have filed with the Department of Insurance.
AB 356: Summary of Underwriting Information filed re conditions for which no insurance coverage will be offered, application will be denied, or higher premium may be charged or benefit may be limited Condition Insurance Company Action
*Health problems for which you have not seen a doctor Automatic decline for some companies
*Health problems that a doctor can not explain Automatic decline for some companies
*Health problems for which you have not completed treatment Automatic decline for some companies*AIDS Automatic decline*Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process Automatic decline*Cancer, under treatment Automatic decline*Sleep Apnea Automatic decline or higher premium will be charged*Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities Automatic decline*Heart disease Automatic decline*Renal failure or Kidney Dialysis Automatic decline*Diabetes with complications Automatic decline*Cirrhosis Automatic decline*Multiple Sclerosis Automatic decline*Muscular Dystrophy Automatic decline*Systemic Lupus Erythematous Automatic decline*History of transplant Automatic decline*Lymphedema Automatic decline or higher premium will be charged*Current infertility treatment Automatic decline*Hepatitis Automatic decline*Hemochromatosis Automatic decline*Rheumatoid Arthritis Automatic decline*Stroke, after 10 years with no reoccurring problems Automatic decline or higher premium will be charged*Allergies, while testing is in process Automatic decline or higher premium will be charged*Ear infections, controlled with medication Higher premium may be charged*Lyme's disease, without symptoms after one year Automatic decline or higher premium will be charged*Breast Implants (non-silicone) Automatic decline or higher premium will be charged*Ringworm Higher premium may be charged*Joint sprain or strain, recovered and no restrictions Higher premium may be charged*Migraine headache, mild and infrequent with no emergency room visits Higher premium may be charged*Mild depression Automatic decline or higher premium may be charged*Obesity Automatic decline or higher premium may be charged*STD (Sexually Transmitted Disease) Automatic decline or higher premium may be charged
Underwriting
When you apply for individual health insurance, the health insurance company uses a process called underwriting to look at your age, sex, and health history to decide whether it will cover you and how much it will cost to provide you coverage.
Do all health insurance companies have the same underwriting guidelines for offering insurance?No. Each insurance company has its own underwriting guidelines, which are usually not made public. However, insurance companies marketing and selling individual health insurance policies in California must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance (Insurance Code
Section 10113.95 which was added by Assembly Bill 356 in 2005).
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