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Do health insurance companies drug test their policyholders?

do health insurance companies drug test policyholdersHealth insurance companies do not normally drug test their policyholders. In fact, health insurance policies often do not require much testing at all, particularly for employer-based health plans. Individual health insurance plans may ask more questions about general health and health history, but even they do not often require an examination or testing.

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While health insurance companies do not often do drug testing directly, a sort of drug screening does often take place for potential policyholders in employer-based health insurance plans. Since some employers implement drug testing as part of their pre-employment screening process, they often screen out candidates who fail drug tests even before they are hired. Some companies do random or incident-based drug testing, so someone could be terminated and eventually dropped from an employer’s health plan as a result of a drug test even after being enrolled.

Why might a provider deny coverage?

As mentioned above, independent health insurance eligibility requirements tend to be a little stricter. There are certain conditions that would often cause an insurance company to deny someone independent health insurance. These are mostly long term and/or serious illnesses that will require a lot of expensive treatment and care.

According to the California Department of Managed Health Care, some illnesses or conditions that may cause an insurance company to turn down a potential independent insurance customer would include:

  • AIDS
  • cancer
  • diabetes with complications
  • lupus
  • cirrhosis
  • sleep apnea
  • heart disease
  • severe psychological disorders
  • ongoing treatment for infertility
  • renal failure
  • hemochromatosis
  • pregnancy
  • hepatitis
  • muscular dystrophy
  • transplant history
  • multiple sclerosis
  • lymphedema

In addition to the specific conditions mentioned above, an independent health insurance company might deny an applicant due to obesity, smoking, drinking or if you have a health problem for which you have not completed treatment. Basically, you need to be in pretty good health with no serious preexisting conditions in order to be assured of qualifying for independent health insurance.

Do life insurance companies drug test clients?

health insurance companies drug test policyholdersLife insurance companies test their policyholders extensively for drugs and other health risks. Their tests may include blood tests, urine tests, hair tests and saliva tests. While in the past tests might be done for marijuana and narcotics, modern drug tests might also include tests for nicotine, since smoking is such a significant health risk.

Life insurance companies do drug testing as part of an overall health assessment, usually including a full physical examination. A life insurance company would like to find out if a potential customer has any conditions that might shorten their life span. That would mean a greater likelihood that the company would lose money on a life insurance policy.

Can health insurers adjust their rates for risk?

In the big picture, all health insurance companies adjust their rates based on risk. Large group health insurance companies spread that cost over the entire group while individual health insurance charges the individual for his or her own personal risk factors. There are more regulations on group health insurance, particularly employer-based group health insurance.

Group health insurers are limited in their ability to adjust the cost of individual premiums, although they can offer bonuses or incentives for people who participate in wellness programs or otherwise take steps to improve their health. Individual health insurance policies can be adjusted to reflect the risk posed by a particular medical condition in a particular customer.

There is some discussion as to the value of allowing health insurance companies to adjust their rates based on individual risk. According to an article published on the Santa Clara University website, the U.S. health care system spends over 177 billion dollars a year on treating problems related to obesity, smoking and drinking alcohol. On the surface it would seem unfair for that cost to be absorbed into the healthcare system and paid in the form of higher premiums by everyone who has health insurance, but there are other ways of looking at it.

While smoking and drinking are health risks, people are unlikely to quit just because they are forced to pay more for their health insurance. It is more likely that they will cut their budget elsewhere. Since a fair amount of smokers and drinkers do not have a lot of disposable income, this means that they may start to spend less on healthy food, medication and warm clothing. Cutting spending in those areas could actually lead to greater health problems and costs.

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