What Factors Affect New Jersey Individual Health Insurance?
When researching individual health coverage, several key factors should be taken into account before choosing a policy. There is a choice between the HMO and PPO approaches to insurance, the level of out of pocket expenses (deductibles and co-pays), and the financial strength of the insurance company to evaluate. But, the most relevant factor to modify your coverage is the insurance company's procedures on the medical underwriting of applicants for new policies.
Medical underwriting of individual insurance plans is somewhat different from the procedures of group insurance programs. Per the law, in a group health plan, there must not be any discrimination in benefits offered to any individual group member based the person's health status. However, for individual health insurance plans, discrimination arising from the health status of the person is a routine practice today and is generally legal! If a person who applies for an individual health care benefits policy has an existing medical condition, the insurance company may refuse coverage to the person or to offer only insurance that excludes the medical condition or disability.
This will occur because of the requirement for medical underwriting of each individual insurance policy which is applied to new policies purchased by consumers in the individual insurance marketplace. What medical underwriting actually means is that the health benefits provider is analyzing the likely financial risk likely to arise from the new policy based on the specific health status of the individual. When considering a new insurance policy, consumers can always call the medical underwriting organization in the health insurance company first to see how they deal with specific health issues.