Denied Individual Health Insurance Coverage? Reasons For Health Insurance Coverage to Be Denied

What should you do if you have been denied health insurance coverage? What options do you have if you have been denied individual health insurance coverage? What are some of the common reasons that health insurance coverage can be denied?

In a nutshell, if you have been rejected individual health insurance coverage due to pre-existing conditions then you should first of all shop around and compare rates from multiple companies. After all, different health insurance companies have different underwriting guidelines and just because you have been denied coverage with one company does not necessarily mean that the next company will do the same. Having the services of an experienced independent health insurance agent at a time like this is a definite plus.

If for any reason you are rejected from receiving health insurance by a company, you may also want to try to look for companies that don’t require you to answer questionnaires, or even better go for some that can give you at least a little coverage for a low-cost – this is a last option though as almost all individual plans that do not have medical underwriting are really just discount plans in disguise and will not give the coverage that a true major medical comprehensive health insurance plan will.

Some states (29 to be exact) have what are called high risk pools. These were created to serve those people that are considered medically uninsurable or those that are described as a “high risk” for the insurance companies. What these pools do is give those people that have been turned down an opportunity of having health insurance. With a high risk pool you will never be turned down for any reason and the best part is that it will help you pay for large medical costs.

There are however, a bunch of things that might be viewed as disadvantages to the customer deciding whether or not to consider a high risk pool. Some of the disadvantages include that the state can terminate your coverage if there is legislation against it, there are usually long waiting lists, the cost is much higher than private health insurance plans and you can lose eligibility if you move or if you start receiving Medicare and Medicaid. If you want to know if your state is one of the 29 that offer “high risk” pools or for more contact information to enroll in one of them then you should speak with a health insurance broker local to your state. Again, keep in mind that a high risk pool should be one of the last options that you consider.

With the Health Insurance Portability and Accountability Act (HIPAA) passed in the year 1996, new doors were opened for the people that weren’t able to qualify for private individual health insurance. Within this act a law was passed that states that a person cannot be denied health insurance for any reason if they decide to join a group health plan. This means that if you have a job with an employer that offers group health insurance coverage, more than likely you won’t be denied coverage. The only way in which coverage wont be given to a person in the even that they seek group health insurance, is in the event that you do not meet the eligibility requirements of your employer.

Some of those eligibility requirements could be the total number of hours you work per week and whether you have a salaried or an hour employee. It is of note to highlight that group health plans may refuse to cover a person with pre-existing conditions; however if you have at least 12 months of continuous creditable coverage, a group plan will not be able to deny you insurance due to pre-existing conditions.

This doesn’t mean that if you have had health insurance in the past and you have a pre-existing condition you are covered. If you have had a break in coverage (lapse in coverage) and you apply for group coverage you will be given an exclusion period. During this exclusion period the insurer will not pay for any treatment or doctor visits related to your pre-existing conditions, instead you will be responsible for all unrelated treatment.

The HIPAA laws also dictate that individual health insurance coverage must be issued on a guaranteed issue basis (everyone is approved) and all pre-existing conditions are covered if someone meets 6 criteria. These 6 HIPAA health insurance requirements are an important part of the HIPAA laws to understand if you have major pre-existing conditions and have been denied for regular individual health insurance coverage.

The Importance of Insurance Planning

When leading a life that is full of activity, it may seem easy to overlook insurance planning because you are busy with other things. These other things can make insurance seem like a lower priority. Insurance planning, however, is a vitally important step in securing your present and your future while allowing you to stay focused on all the activities that are important to you.

Insurance Provides Security to Those Who Matter Most

By providing financial recompense for damages to property, insurance helps ensure that a family remains financially secure well into the future. Without insurance an individual would have to take from his own savings in order to make himself whole after an insurable incident. While he may be making himself whole in terms of property, he would be creating a financial hole by draining his savings account or increasing his debt.

Insurance is Perfect for Emergency Planning

Insurance provides an affordable means to plan for emergencies. Without insurance backing an individual during an emergency, one would have to save a lot of money just to repair or replace everything that could be damaged in a flood, hurricane, fire, theft or other peril.

Insurance can also provide a loss use benefit which creates a backup plan for operating a business, and driving or housing a family after an emergency. Without this assistance, it would be very difficult and expensive to provide these short term replacements.

Insurance Ensures Good Karma

Liability insurance coverage allows one to make good on hospital bills and lost wages that she may have caused another person accidentally. No one wants to hurt another through a car accident, fire, or other unexpected incident but if it happens it feels good to know that the injured individual can recover from those financial damages as quickly as possible. Without liability insurance coverage one might not be able to make good on liabilities on her own.

Insurance Provides Support for Heirs

A life insurance policy can ensure that heirs have a means of replacing a decedent’s income after they have gone. If you leave loved ones without the resources of a life insurance death benefit means that they have to scramble to afford all the same bills but on less income. This can not only force them to significantly change their way of life now, but can also hamper their ability to achieve their dreams of college and retirement.

How an Insurance Policy Works

Insurance is synonymous to a lot of people sharing risks of losses expected from a supposed accident. Here, the costs of the losses will be borne by all the insurers.

For example, if Mr. Adam buys a new car and wishes to insure the vehicle against any expected accidents. He will buy an insurance policy from an insurance company through an insurance agent or insurance broker by paying a specific amount of money, called premium, to the insurance company.

The moment Mr. Adam pay the premium, the insurer (i.e. the insurance company) issue an insurance policy, or contract paper, to him. In this policy, the insurer analyses how it will pay for all or part of the damages/losses that may occur on Mr. Adam’s car.

However, just as Mr. Adam is able to buy an insurance policy and is paying to his insurer, a lot of other people in thousands are also doing the same thing. Any one of these people who are insured by the insurer is referred to as insured. Normally, most of these people will never have any form of accidents and hence there will be no need for the insurer to pay them any form of compensation.

If Mr. Adam and a very few other people has any form of accidents/losses, the insurer will pay them based on their policy.

It should be noted that the entire premiums paid by these thousands of insured is so much more than the compensations to the damages/losses incurred by some few insured. Hence, the huge left-over money (from the premiums collected after paying the compensations) is utilized by the insurer as follows:

1. Some are kept as a cash reservoir.

2. Some are used as investments for more profit.

3. Some are used as operating expenses in form of rent, supplies, salaries, staff welfare etc.

4. Some are lent out to banks as fixed deposits for more profit etc. etc.

Apart from the vehicle insurance taken by Mr. Adam on his new vehicle, he can also decide to insure himself. This one is extremely different because it involves a human life and is thus termed Life Insurance or Assurance.

Life insurance (or assurance) is the insurance against against certainty or something that is certain to happen such as death, rather than something that might happen such as loss of or damage to property.

The issue of life insurance is a paramount one because it concerns the security of human life and business. Life insurance offers real protection for your business and it also provides some sot of motivation for any skilled employees who decides to to join your organization.

Life insurance insures the life of the policy holder and pays a benefit to the beneficiary. This beneficiary can be your business in the case of a key employee, partner, or co-owner. In some cases, the beneficiary may be one’s next of kin or a near or distant relation. The beneficiary is not limited to one person; it depends on the policy holder.

Life insurance policies exist in three forms:

• Whole life insurance

• Term Insurance

• Endowment insurance

Whole Life Insurance

In Whole Life Insurance (or Whole Assurance), the insurance company pays an agreed sum of money (i.e. sum assured) upon the death of the person whose life is insured. As against the logic of term life insurance, Whole Life Insurance is valid and it continues in existence as long as the premiums of the policy holders are paid.

When a person express his wish in taking a Whole Life Insurance, the insurer will look at the person’s current age and health status and use this data to reviews longevity charts which predict the person’s life duration/life-span. The insurer then present a monthly/quarterly/bi-annual/annual level premium. This premium to be paid depends on a person’s present age: the younger the person the higher the premium and the older the person the lower the premium. However, the extreme high premium being paid by a younger person will reduce gradually relatively with age over the course of many years.

In case you are planning a life insurance, the insurer is in the best position to advise you on the type you should take. Whole life insurance exists in three varieties, as follow: variable life, universal life, and variable-universal life; and these are very good options for your employees to consider or in your personal financial plan.

Term Insurance

In Term Insurance, the life of the policy-holder is insured for a specific period of time and if the person dies within the period the insurance company pays the beneficiary. Otherwise, if the policy-holder lives longer than the period of time stated in the policy, the policy is no longer valid. In a simple word, if death does not occur within stipulated period, the policy-holder receives nothing.

For example, Mr. Adam takes a life policy for a period of not later than the age of 60. If Mr. Adam dies within the age of less than 60 years, the insurance company will pay the sum assured. If Mr. Adam’s death does not occur within the stated period in the life policy (i.e. Mr. Adam lives up to 61 years and above), the insurance company pays nothing no matter the premiums paid over the term of the policy.

Term assurance will pay the policy holder only if death occurs during the “term” of the policy, which can be up to 30 years. Beyond the “term”, the policy is null and void (i.e. worthless). Term life insurance policies are basically of two types:

o Level term: In this one, the death benefit remains constant throughout the duration of the policy.

o Decreasing term: Here, the death benefit decreases as the course of the policy’s term progresses.

It should be note that Term Life Insurance can be used in a debtor-creditor scenario. A creditor may decide to insure the life of his debtor for a period over which the debt repayment is expected to be completed, so that if the debtor dies within this period, the creditor (being the policy-holder) gets paid by the insurance company for the sum assured).

Endowment Life Insurance

In Endowment Life Insurance, the life of the policy holder is insured for a specific period of time (say, 30 years) and if the person insured is still alive after the policy has timed out, the insurance company pays the policy-holder the sum assured. However, if the person assured dies within the “time specified” the insurance company pays the beneficiary.

For example, Mr. Adam took an Endowment Life Insurance for 35 years when he was 25 years of age. If Mr. Adam is lucky to attain the age of 60 (i.e. 25 + 35), the insurance company will pay the policy-holder (i.e. whoever is paying the premium, probably Mr. Adam if he is the one paying the premium) the sum assured. However, if Mr. Adam dies at the age of 59 years before completing the assured time of 35 years, his sum assured will be paid to his beneficiary (i.e. policy-holder). In case of death, the sum assured is paid at the age which Mr. Adam dies.

40+ Home Insurance Savings Tips

Your dwelling is often your most precious asset that you need to protect. We created a list of all savings opportunities associated with Home insurance. This list is the most complete perspective on home insurance savings tips. Numerous insurance brokers contributed to this list. So, let’s start!

1. Change your content coverage: Renting a Condo? You can often lower your content coverage. No need to insure your belongings to up to $250,000 if you only have a laptop and some IKEA furniture!

2. Renovations: Renovating your house can result in lower home insurance premiums, as home insurance premiums for older, poorly maintained dwellings are usually higher. Additionally, renovating only parts of your dwelling (e.g. the roof) can lead to insurance savings.

3. Pool: Adding a swimming pool to your house will likely lead to an increase in your insurance rates since your liability ( e.g. the risk of someone drowning) and the value of your house have increased.

4. Pipes: Insurers prefer copper or plastic plumbing – maybe it is a good idea to upgrade your galvanized / lead pipes during your next renovation cycle.

5. Shop around: Search, Compare, and switch insurance companies. There are many insurance providers and their price offerings for the same policies can be very different, therefore use multiple online tools and talk to several brokers since each will cover a limited number of insurance companies.

6. Wiring: Some wiring types are more expensive or cheaper than others to insure. Make sure you have approved wiring types, and by all means avoid aluminum wirings which can be really expensive to insure. Not all insurers will cover houses with aluminum wirings, and those that would, will require a full electrical inspection of the house.

7. Home Insurance deductibles: Like auto insurance, you can also choose higher home insurance deductibles to reduce your insurance premiums.

8. Bundle: Do you need Home and Auto Insurance? Most companies will offer you a discount if you bundle them together.

9. New Home: Check if insurer has a new home discount, some insurers will have them.

10. Claims-free discount: Some companies recognize the fact that you have not submitted any claims and reward it with a claim-free discount.

11. Mortgage-free home: When you complete paying down your house in full, some insurers will reward you with lower premiums.

12. Professional Membership: Are you a member of a professional organization (e.g. Certified Management Accountants of Canada or The Air Canada Pilots Association)? Then some insurance companies offer you a discount.

13. Seniors: Many companies offer special pricing to seniors.

14. Annual vs. monthly payments: In comparison to monthly payments, annual payments save insurers administrative costs (e.g. sending bills) and therefore they reward you lower premiums.

15. Annual review: Review your policies and coverage every year, since new discounts could apply to your new life situation if it has changed.

16. Alumni: Graduates from certain Canadian universities ( e.g University of Toronto, McGill University) might be eligible for a discount at certain Insurance providers.

17. Employee / Union members: Some companies offer discounts to union members ( e.g. IBM Canada or Research in Motion)

18. Mortgage insurance: Getting mortgage insurance when you have enough coverage in Life insurance is not always necessary: mortgage insurance is another name for a Life/Critical Illness / Disability insurance associated with your home only but you pay extra for a convenience of getting insurance directly when lending the money. For example a Term Life policy large enough to pay off your home is usually cheaper.

19. Drop earthquake protection: In many regions, earthquakes are not likely – you could decide not to take earthquake coverage which could lower your premiums. For example, in BC earthquake coverage can account for as much as one-third of a policy’s premium.

20. Wood stove: Choosing to use a wood stove means higher premiums – Insurance companies often decide to inspect the houses with such installations before insuring them. A decision to get rid of it means a lower risk and thus lower insurance premiums.

21. Heating: Insurers like forced-air gas furnaces or electric heat installations. If you have an oil-heated home, you might be paying more than your peers who have alternative heating sources.

22. Bicycle: You are buying a new bicycle and thinking about getting extra protection in case it is stolen when you leave it on the street e.g. when doing your groceries? Your Home insurance might be covering it already.

23. Stop smoking: Some insurers increase their premiums for the homes with smokers as there is an increased risk of fire.

24. Clean claim history: Keep a clean claim record without placing small claims, sometimes it makes sense to simply repair a small damage rather than claim it: you should consider both aspects: your deductibles and potential raise in premiums.

25. Rebuilding vs. market costs: Consider your rebuilding costs when choosing an insurance coverage, not the market price of your house (market price can be significantly higher than real rebuilding costs).

26. Welcome discount: Some insurers offer a so called welcome discount.

27. Avoid living in dangerous locations: Nature effects some locations more than others: avoid flood-, or earthquake-endangered areas when choosing a house.

28. Neighbourhood: Moving to a more secure neighbourhood with lower criminal rate will often considered in your insurance premiums.

29. Centrally-connected alarm: Installing an alarm connected to a central monitoring system will be recognized by some insurers in premiums.

30. Monitoring: Having your residence / apartment / condo monitored 24 hour can mean an insurance discount. e.g. via a security guard.

31. Hydrants and fire-station: Proximity to a water hydrant and/or fire-station can decrease your premiums as well.

32. Loyalty: Staying with one insurer longer can sometimes result in a long-term policy holder discount.

33. Water damages: Avoid buying a house which may have water damage or has a history of water damage; a check with the insurance company can help to find it out before you buy the house.

34. Decrease liability risk: Use meaningful ways to reduce your liability risk (e.g. fencing off a pool) and it can result in your liability insurance premiums going down.

35. Direct insurers: Have you always dealt with insurance brokers / agents? Getting a policy from a direct insurer (i.e. insurers working via call-center or online) often can be cheaper (but not always) since they do not pay an agent/broker commission for each policy sold.

36. Plumbing insulation: Insulating your pipes will prevent them from freezing in winter and reduce or even avoid insurance claims.

37. Dependent students: Dependent students living in their own apartment can be covered by their parents’ home insurance policy at no additional charge.

38. Retirees: Those who are retired can often get an additional discount – since they spend more time at home than somebody who works during the day and thus can prevent accidents like a fire much easier.

39. Leverage inflation: Many insurers increase your dwelling limit every year by considering the inflation of the house rebuilding costs. Make sure this adjustment is in line with reality and that you are not overpaying.

40. Credit score: Most companies use your credit score when calculating home insurance premiums. Having a good credit score can help you to get lower insurance rates.

41. Stability of residence: Some insurers may offer a stability of residence discount if you have lived at the same dwelling for a certain number of years.