Individual Health Insurance Regulations

Understand your state's individual health insurance regulations.

The health insurance market is divided between two broad categories of insurance: individual and group. Along with this division in insurance regulations, individual health insurance regulations differ from group health insurance regulations in many states and each state's individual health insurance laws vary. Individual health insurance does, however, have some laws which are common across all states.

Pre-Existing Conditions

Most states allow pre-existing conditions to be excluded for a period of time, which is often stipulated by the law. Some states allow health insurers to add riders to their health insurance that will allow the insurance company to permanently exclude some health conditions. Other states ban permanent exclusions but allow the insurer a longer exclusion period for all health conditions. Some states, like Massachusetts, do not allow pre-existing condition exclusions at all.

Coverage For Children

Most states force insurance companies to cover newborn and newly-adopted children for 30 to 31 days if the policy already allows coverage for dependent children. After this time period, the parents must add the child to the policy. Some insurance companies request that the parents put the child on the policy during this 30 to 31-day time frame if they want to continue coverage for their children beyond the initial period of automatic coverage.

Disabled Children

Disabled individuals are often covered under their parent's policy beyond the maximum age limit specified in the policy for dependent children if the parents can prove that their children are dependent on them because of a physical or mental disability.

Guaranteed Renewability

Many states mandate a guaranteed renewal feature on all policies. The mandate is made provided that the insured already has insurance, that insurance premiums are paid on time and that no misrepresentations were made by the insured on the application for insurance. If those provisions are met, the insured will be able to renew the policy regardless of their health status.

References

• "Practicing Financial Planning for Professionals, Practitioner's 10th edition"; Sid Mittra, Anandi P. Sahu, Robert A Crane; 2007
• "Ernst & Young's Personal Financial Planning Guide, 5th Edition"; Martin Nissenbaum, Barbara J. Raasch, Charles L. Ratner; 2004
• "Life & Health Insurance, License Exam Manual, 6th Edition"; Dearborn Financial; 2004
• http://www.healthinsuranceinfo.net/: Health Insurance Regulations By State