To understand your problem is to understand state health insurance regulations in Utah. They allow insurance carriers to decline and or rate up pricing for private health insurance based upon certain health conditions which cause you to be labeled uninsurable. This is very much different than employer offered insurance which is controlled by federal laws that prohibit denial of coverage for health conditions. Most people get stuck in this “denial jam” if they are between jobs or self employed. The good news is that coverage is available EVEN with carriers that may have declined you already. You just have to know how to secure it.
What is “High risk health insurance”? You can define this in several ways such as coverage obtainable from three sources. Source 1 would be from a COBRA policy. COBRA policy is usually very expensive with the trade off being that your medical conditions are covered for at least 18 months. From a underwriters perspective, COBRA is a high risk insurer proposition because of the carrier being locked into liability of claim payments for 18 months. Most COBRA premiums run around $900 per month for a middle aged family. Source 2 would be with the STATE HIGH RISK POOL. You would qualify for that if you didn’t have access to COBRA benefits or a private health insurance policy. They require you to be declared “uninsurable” by private health insurance issued by either ALTIUS, SelectHealth Plans (IHC) and Regence BlueCross BlueShield of Utah.
The premium for the state pool is around $400 per month per family member whom is determined to be uninsurable. Only the uninsurable family members will be issued a policy through this program. The other insurable family members would have to secure a policy through channels such as ALTIUS, SelectHealth Plans (IHC) and Regence BlueCross BlueShield of Utah. The State high risk pool deductible is around $2,500 with options of 50/50 coinsurance. Source 3 would be a INTERIM or SHORT TERM policy.
Typically the coverage is very low priced if the insured agrees to accept a medical rider for the health conditions that caused “declined health insurance”. The trade off is beneficial for people that are not being actively treated for the medical condition that caused the decline in the first place! You have to understand that logic does not apply with an normal healthy person being declined for a medical condition or use of prescriptions in the past. The state insurance regulations allow these declinations. We have always said that if in the next life there is not a hell…there should be just to burn underwriters! Many people can actually secure a reputable health insurance policy to cover them for everything else and elevate the risk of going “Uninsurable”. We can make recommendations of getting prescription coverage as long as you take the responsible step of securing a health insurance policy to hedge off financial disaster.
At BenefitsManager.net we like to clarify and warn Utah residents of the following:
What “High risk health insurance” IS NOT! Basically any type of indemnity insurance policy. Many reputable carriers such as AFLAC and ALLSTATE offer these. They are normally called hospital plans, accident plans, cancer policies, etc. These are not functioning health insurance policies! They only pay a limited and or specified amount of money per occurrence. They will not cover the costs of treatments or the bills associated. Unfortunately much mis-representation takes place in the market of how these policies actually work.
Discount health plans are dangerous and currently under investigation by the Utah State Insurance Department. We must make it clear that these type of plans are NOT insurance. They only give you access to a limited doctor panel that will agree to treat you at a discounted rate. Currently there are several entities making claims that it is an insurance policy which in fact they are not and they have not been approved so by the Utah State Insurance Department. These discount health plans do not meet the basic definition of insurance policy. Nor do they provide coverage for medical conditions or the definition here in.