Published: May 16, 2008 12:51 pm            

Q&A with John Oxendine

By John Oxendine

Georgia Insurance and Fire Commissioner



Q: Since health insurance isn’t offered where I work, I’m applying for an individual health policy. What should I look for when filling out the application?

A: Insurance companies scrutinize individual health applications closely, reviewing the information you provide. To help make the application process easier, keep the following information in mind when securing an individual health care policy for yourself and your family. The insurance company may request:

-- Common information such as name, address, Social Security number, marital status, dependents and whether any of the applicants have other health insurance coverage in force or are covered under Medicaid/Medicare programs.

-- The date you would like coverage to be effective.

-- Health information about yourself and other family members desiring coverage. Extensive medical and health information will be expected for the applicant and any other family member listed on the application. The information requested can vary, so pay close attention to the number of years of medical history required and the exact health information requested.

-- Whether anyone listed on the application has previously been declined health, disability or life insurance, or had their health, disability or life insurance cancelled or rescinded.

-- If you answer “yes” to any of the background health questions on the application, provide the name of the family member, their physician’s information and the exact details regarding the dates and nature of their condition.

To ensure you do not inadvertently fail to disclose material information, you should retrieve all of your medical records. Some physicians might ask you to send your request in writing or charge a fee for reproducing your medical records. As a general rule, it is a good idea to request a copy of your files each time you switch doctors.

Even if an insurance company approves your coverage, it might restrict coverage of pre-existing conditions completely or for a specified period of time. Sometimes pre-existing conditions will cause a claim to be denied or raise your premium. A pre-existing condition is a physical or mental condition for which medical advice, a diagnosis, or care or treatment is recommended or received within a certain period of time before the enrollment date of the policy.

However, once you are accepted for coverage, the company may only cancel your policy for nonpayment of premium or for a deliberate falsification of a material fact, such as a omitting a pre-existing condition from an application.

The last part of the application is an agreement that typically states any dishonesty or failure to disclose requested or material information could result in an approved insurance contract being terminated. Giving accurate and honest answers will save you possible problems later. Sign the health insurance application only after you have reviewed it carefully to be sure the answers are complete and accurate.

Insurance companies will use the medical information obtained on the health insurance application to determine your premium rates. Occasionally, insurance companies will need additional information from your physician or another medical provider.

Once the health status of all applicants listed on the application is determined and the application is accepted, a rate class is assigned and the applicant is put into a pool with other insureds with similar risk characteristics. The premium rate will be charged to that entire class of customers and subsequent annual renewal premiums will be determined by the claims experience of the entire pool.





Please send your insurance questions to:

Insurance Commissioner John Oxendine

716 West Tower

2 Martin Luther King Jr. Drive

Atlanta, Georgia 30334

Or call 404-656-2070 (toll free at 1-800-656-2298), from 8 a.m. to 7 p.m. weekdays, for assistance with an insurance question.

Website www.gainsurance.org

        

• Click to discuss this story with other readers on our forums.