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Underwriting

Florida is one state where everyone is subject to the underwriting whims of the insurance company that they apply to.  Every carrier is different, but only slightly.  For instance, no insurance company is going to accept you if you are HIV positive or are currently undergoing serious medical treatments.  Heck even breast implants are often ridered out of the policy.  Currently, no Florida company is accepting children under 19 unless they are on a plan with a parent(s).

Here is a list from a popular Florida health insurance company of unacceptable conditions;

Applications should not be written for individuals age 19 and over who:

  1. Live in a non-operational service area for the product being sold. If you live year round in Texas, don’t apply for a Florida health plan.  For those that have multiple residences, call us to see which one is the right one to use for your health application.  If you apply with United, Humana, or Aetna or some other national company you will want to use your correct address.
  2. Applicants with an ineligible occupation.  Many health insurance companies will charge rodeo clowns or some other similarly dangerous pursuit higher premiums or in some cases won’t even accept the person.  We usually refers to dangerous occupations as sales at East Coast Health Insurance (wink, wink).
  3. Are about to be seen by a physician or about to enter a hospital, sanitarium, rest home, prison or other institution, or who are sick, infirm, or otherwise not healthy at the time of the application.  Yes until 2014, it is not possible to get health insurance from the back of an ambulance.  Indeed, if you knowingly apply for health insurance while suffering from an ailment you could have your policy rescinded.  Notice I did not say arrested. It is not illegal to lie on an application, and in some cases it might be a suitable risk, as they refund all your premiums after a recission.  Just don’t tell your health broker what you are doing!
  4. Have a medical appointment scheduled within the next 30 days, including appointments for routine physicals, until after the physician has been seen and all test results are known (generally two weeks after the exam).
  5. Recently had or anticipate testing or surgery and have not been released from the physician’s care.  This is identical to number 3 and 4.
  6. Are pregnant women, spouses of pregnant women, pregnant dependents, or prospective fathers until after delivery and released from the physician’s care (GENERALLY, AFTER THE SIX WEEK CHECK-UP). NOTE: Prospective fathers include married and single individuals. Pregnant women should call Medicaid as it is easy to get Medicaid during pregnancy.  In fact, Medicaid sometimes seems like it was only invented for pregnant women as it is so difficult to get for anyone else.  I personally am paying $7,000 to deliver my wife’s baby as we never got maternity health insurance, which was a bad decision.
  7. Is a dependent child, over the age of 30, on a family application. Due to the new health reform law, it is now legal to stay on your parent’s plan until age 30 in Florida and age 27 in most other states.
  8. Are currently receiving Social Security Disability and/or early Medicare benefits, or unable to work due to disability or receiving Workers’ Compensation or disability income benefits.  Yes no insurance company will take someone actively receiving Medicaid or Disability payments for obvious reasons.  Sometimes, people do get disability but not Medicaid which is illogical but true.  If you have disability insurance be sure to explore Medicaid or other Florida programs for those that don’t qualify for health insurance.
  9. Are an eligible employee currently enrolled for group coverage.  This is one of those situations where if you have group coverage, you might not be able to get off of it until Open Enrollment.  Be sure to ask your Human Resources representative if you are eligible to go to individual health insurance.
  10. Reside in Florida less than six full consecutive months of the year. Really this is different for every carrier.  It also matters where you file your taxes.  Call us if you have an issue with this one at 888 803 5917.
  11. Are a Non U.S. citizen who has been in the United States for less than six full consecutive months, or are visiting the United States on a temporary basis. In order to get health insurance you need either a social security number or some type of tracking number.  We can sometimes do a magic trick though, so don’t let this one get you down if it applies to you.  Instead, call us now!
  12. Have been medically rejected for coverage by Individual Medical Underwriting in the past year, unless otherwise instructed by the Individual Medical Underwriting Department that a new application may be completed. This is universally not correct and is this carriers way of saving money.  If you have been declined however, you might eligible for PCIP or a similar program.  Let us help you navigate this system by calling us (again its 888 803 5917).
  13. Have been previously rejected by Individual Medical Underwriting due to outstanding information needed to determine insurability. A new application should not be completed until authorized by the Individual Medical Underwriting Department after review of the outstanding information. If you have been declined in the past by a carrier, you might be eligible for coverage now.  Remember, most conditions have a 5 or 10 year look back period.  Once this period is past, the condition cannot be used against. Breast cancer usually has a 2 year look back.
  14. Refuse to provide their social security number , Social Security Numbers are for internal use only. Contracts are assigned a policy number. We see this all the time.  If you are afraid to give your social we cannot bind your health insurance.  Moreover, if you are so concerned about identity theft, you should consider privacyguard.com or some similar company to watch your credit.
  15. Are unable to sign or e-sign his or her application for whatever reason (other than a minor child under the age of 18 in which case the parent is required to sign). A power-of-attorney is not acceptable. Obviously, this carrier is looking to disqualify medically insufficient people.
  16. Will become age 65 as of the proposed effective date of coverage. No health insurance company wants to pay to underwrite someone for 2-3 months.  And quite frankly, most people in this situation looking for individual health insurance have a COBRA option and just don’t want to pay the high bill.  Take it from me though, if you are 64, COBRA is not a bad deal!
  17. Are applying for the HMO product and have health history requiring a Medical Exclusionary Rider; this type of applicant is unacceptable for the HMO product.
  18. Primary Applicant is less than 19 years old.  No children  only policies in Florida except for short term health insurance (which is not a long term solution if you get my drift). Florida Kid Care is a viable option in this circumstance.

The application is a very important part of the health insurance application. However, it is only half of what goes into considering you as a viable risk. All companies will also pull your MIB (Medical Information Bureau owned by United Health Care) and your prescription history. This is an important reason of why it is important to only go to mom and pop pharmacies who will share your information with everyone. In some situations, the health insurance company will also request your medical records from your doctor(s).  It is getting increasingly more difficult during this digital age to put one over on the insurance company.  They all share data too so they are likely to find out everything unless you are purposefully careful.