FAQs FOR INDIVIDUAL HEALTH INSURANCE PLANS

Q.  Do medical questions have to be answered to get an Individual health policy?
A.    Yes.   Generally most all insurance companies are for-profit companies.  That means, like any other business they are in business to make money.  One of the ways they can control their losses is to protect against high losses by not insuring someone who has a high risk potential for large claims.  They do that by screening applicants with medical questions.  Since insurance companies cannot cancel an insured because of claims they have to be careful with their underwriting when they approve or deny writing a policy

Q.    Can an insurance company cancel my policy because I    
         have medical claims?
A.    No.  Your coverage cannot be canceled because you get sick. This is called "guaranteed renewability" and guaranteed renewable means they have to renew your insurance each year.  You have this protection provided that you pay the premiums, they can and will cancel you for not paying your premium.

Q.    Can an insurance company raise my rates if I have too
         many claims?
A.    Individual Health Insurance is generally issued in “pools” of insurance policies.  The insurance company will not single you out to raise your rates but they can and do raise rates based on the number of claims that occur in your insurance pool. Generally a “pool” of individual insurance policies is larger than most group insurance policies, therefore individual insurance may not get as high an increase on their annual renewal as many group policies do.
Missouri is an open competition state and, as such, does not have the authority to regulate premiums on most types of health insurance.  Missouri relies on competition among companies to determine the premium rates.

Q.   What is a preexisting condition?
A.    This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy. The definition can vary from policy to policy.  Sometimes companies will place an “exclusion” on a preexisting condition, meaning they will not cover that condition at all.  Sometimes companies will place a “waiting period” (usually one to two years) before they will cover a preexisting condition.

Q.  If I change from one individual health policy to another, can the new company impose preexisting condition exclusion on the new policy?
A.  Yes

Q.  What can I do if I am turned down for a Health Policy due to my medical condition?
A.   Anyone who is a resident of Missouri is eligible for major medical expense coverage through the Missouri Pool.  Preexisting conditions are excluded for a
period of 12 months.  Other limitations and requirements apply, please consult an agent at Wells Financial Services to discuss your eligibility.