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How do health insurance companies qualify you for coverage?

stethoscope health insurance coverageHealth insurance is important coverage to get if you want to protect your financial stability and overall good health. Finding the right health insurance company is an important process. The right insurance company is the one that will best fit your health insurance needs and financial budget.

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Health insurance companies use a variety of aspects to qualify you for health coverage. Attributes such as age, gender, current health, and particular habits are all used to qualify a potential customer for coverage.

There are rules and regulations governing how health insurance companies can qualify you for coverage.

How are certain aspects used to qualify someone for coverage?

Many group health insurance companies can remain stable, and make a profit, when their customers pay more in health insurance premiums than the company pays out to health service providers. Health insurance companies want to have customers with the least amount of risk of having to actually use the insurance coverage; statistically speaking, certain aspects make a potential customer more likely to need health insurance.

Age is one aspect that can determine how likely someone is to need health insurance. Those who are young in age or older in age are statistically more likely to use health insurance. Coverage may be harder to find, or more expensive, for someone who is young, or someone who is old, because they have a higher risk.

Past health and current health are both used to assess further risk. If an individual has had a major health event in the past, such as a heart attack, or has a health condition, such as high blood pressure, then it is more likely for the individual to need to use health coverage. Past or current health can even disqualify an individual from some insurance coverage.

Marriage is another factor thathealth insurance companies use to qualify an individual for coverage. Studies have shown that men and women who are married tend live longer, healthier lives. This lowers a person’s risk for having to use health insurance coverage, and it can make it easier or more affordable to qualify for coverage.

Gender is also used to qualify an individual. On average, men are more likely to take risks that can lead to an accident or to suffer from a disease or medical condition. Thus, women have a lower risk than men seeking health insurance do, and they are more likely to find it easier to qualify for health insurance coverage.

Certain habits also play a part in an individual’s ability to qualify for coverage. Habits that raise the chance of disease or poor health, such as smoking, will have a negative impact on anyone’s ability to qualify for health insurance; such habits can actually singularly disqualify an individual for coverage because they create too much of a risk.

What about the health insurance provided by an employer?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set rules for group health plans provided by employers. Under HIPAA law, an insurer that provides group health insurance to a company cannot discriminate against any participant in the plan.

That means that the insurer cannot set different qualifying rules, higher premiums, or different kinds of coverage to any participant in the health plan regardless of risk. However, the employer can choose to change the plan or provider, but the changes will take effect for all participants.

Can a pre-existing condition keep someone from qualifying for health insurance?

A pre-existing condition is any disease, disorder, illness, or health issue that was in effect prior to the purchase of a health insurance policy.

According to the National Association of Insurance Commissioners, a private insurance company can deny coverage for any reason. However, once a policy is purchased, under HIPAA law, the insurance company cannot refuse to pay for services for a pre-existing condition if the customer had prior continuous coverage with another policy. If the customer had no prior insurance, then pre-existing coverage can be excluded no longer than twelve months.

Furthermore, new legislation under The Affordable Care Act of 2010 preventshealth insurance providers from denying coverage to children under the age of 19 for any pre-existing condition. The numbers boast of 70,000 children that will actually have health insurance under the law; also, 90,000 children will now qualify for certain benefits that were once denied because of a pre-existing condition.

Exclusion from qualifying for health insurance because of a pre-existing condition is such a barrier for so many U.S. citizens that the Act has other provisions that will be enacted by 2014. For instance, a Pre-Existing Condition Insurance Plan will be created to help those who cannot qualify for other coverage because of a pre-existing condition.

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