Accident and Health FAQ
- Group Health
- Can my employer change our health insurance carrier and
level of benefits during the year?
What happens when my group health coverage ends?
- COBRA Benefits
- What happens to my group health coverage if leave my employer?
- Individual Health
- Can my health insurance carrier continue to raise my premium
Can health insurance companies deny my application for individual insurance due to a health condition?
What is a pre-existing condition?
If I change from one individual health policy to another, can the company impose pre-existing condition exclusion on the new policy?
- Medigap (Medicare Supplements)
- When should I apply for a Medigap policy?
I am not satisfied with the company I have my Medigap policy with. How often can I switch companies?
- Can my employer change our health insurance carrier and level of benefits during the year?
- Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.
- What happens when my group health coverage ends?
- You can apply for individual health coverage under the federal law Health Insurance Portability and Accountability Act (HIPAA). This type of policy is issued on a guaranteed issue basis if you meet the qualifying criteria. However, there is no limit on the maximum premium the company can charge. Pre-existing conditions are waived.
The Missouri Health Insurance Pool (MHIP) offers individual health coverage for persons who have been turned down in the private market, involuntarily terminated from their health care coverage, being charged more than 300 percent of standard premiums for health insurance, qualify for the federal Health Coverage Tax Credit or are now enrolled as HIPPA eligibles in plans offered by the state's indvidual insurers and HMOs.
- What happens to my group health coverage if I leave my employer?
Under federal and state law, employers that have a group health plan are required to offer their employees (and their dependents) the option of continuing their membership in the group plan at their own expense after they leave their job. This is known as "electing COBRA," and these employees are entitled to continue coverage for 18 months.
Missouri requires an insurer to alert terminated employees with a written notice that specifies the date on which their employee benefits will be canceled and the employee’s rights to elect COBRA. Events that qualify for continuation of coverage:
- Voluntary or involuntary termination of employment for any reason except gross misconduct - employee entitled to continuation.
- Death of a covered employee - spouse and dependent children entitled to continuation.
- Divorce or legal separation of a covered employee - spouse and dependent children entitled to continuation.
- Covered employee becomes eligible for Medicare - spouse and dependent children entitled to continuation. Loss of child coverage due to age - child entitled to continuation.
- Federal COBRA law governs employers with 20 or more employees, while state “mini-COBRA” law governs employers with fewer than 20. The laws are identical.
- Can my health insurance carrier continue to raise my premium rates?
- Yes. Missouri is an open competition state and, as such, we do not have the authority to regulate premiums on most types of health insurance. Our state relies on competition among companies to determine the premium rates. Medigap (Medicare supplement) insurance premiums are subject to some regulatory oversight.
- Can health insurance companies deny my application for individual insurance due to a health condition?
- Yes, the company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage, your policy can only be terminated for one of two reasons. The company can cancel your policy for failure to pay your premiums in a timely manner or if you misrepresent information on the application or fail to disclose known information, the company may rescind the policy for material misrepresentation.
- What is a pre-existing condition?
- This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy. The definition can vary from policy to policy.
- If I change from one individual health policy to another, can the company impose pre-existing condition exclusion on the new policy?
Medigap (Medicare Supplements)
- When should I apply for a Medigap policy?
- When you elect coverage under Medicare Part B either due to age or disability, you have a six-month open enrollment for a Medigap policy, which guarantees you coverage with a plan and company of your choice. You may choose from the 10 standardized plans (A-J). If you do not buy a plan within your six-month open enrollment, any company you apply with can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO. Please contact us about these.
- I am not satisfied with the company I have my Medigap policy with. How often can I switch companies?
- Each year on your Medigap annual anniversary date you can switch companies as long as you apply for the same plan (A-J) that you currently are enrolled in and you apply for the policy within 30 days before or after your annual anniversary date.