Can health insurance companies require tests before covering me?

Many people worry about health insurance companies requiring medical tests before they can get insurance. This stems from the fear of discovering some type of preexisting condition. The good news is that while health insurance companies can require medical screenings most companies do not. The bad news is the reason they do not is because they can access all of your medical records already.

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Employers can require prescreening tests, however. They can use your test results to offer you lower insurance rates. According to the Oregon Department of Insurance, regulations prevent employers from denying coverage based on health. They can use certain tests to deny employment though.

Other insurance companies can also require medical screenings before selling you a policy. Life insurance companies will almost always require you submit to medical tests.

What types of tests are usually included in a medical screening?

Medical screenings can seem scary if you are not sure what they are looking for. In most cases the company will have someone come to your home or office to administer the test and collect samples. Sometimes you will be sent to a lab or doctor’s office but the company will pay for the test.

For most people the tests will only include checking things like body weight, blood pressure, and check your heart. The will collect blood and urine samples to test for drugs, including prescription, nicotine, diabetes, and cholesterol. They may also test for HIV.

Insurance companies may also require a stress test or EKG if you are over a certain age or they feel you are at higher risk for having heart problems. Older applicants may also need to submit to memory testing. This usually involves remembering a specific set of objects at the end of their exam that they were told to remember before the exam started.

Why do employers use these tests?

Employers can request results of tests for illegal drugs and nicotine. They can use the results of these tests to deny or terminate an employee if they have an established policy against the use of these substances. Test results containing medical information are confidential and will only be used by insurance companies to determine rates.

Employers may offer or require employees enter into a wellness program as part of their group health insurance. These plans are usually free and employees are monitored every so often for improvement. If their overall health screening improves they will be offered lower insurance premiums, but if it gets worse the premiums may be raised.

Why should I claim any preexisting conditions when I apply for insurance?

It can be hard to find health insurance for people with preexisting conditions; these conditions may cause you to pay higher premiums or be denied coverage. Many people are tempted to try and hide medical problems. This is a big mistake. Health insurance companies can cancel your coverage if fraud is discovered, and they can take legal action against you as well.

Health insurance companies may not require a medical screening before you get insurance but you will have to fill out forms that are used to assess your risk factors. They will request your medical records from doctors, hospitals, and prior insurance companies.

Your medical records will be compared with the forms you filled out as well as your prior insurance coverage. If your coverage has lapsed for more than six months insurance companies will be able to include preexisting condition clauses that limit the care you can receive. If you are applying for private insurance they can use this to deny coverage.

There is hope though. The Affordable Care Act has provisions for preexisting conditions. Policies written after 2010 cannot penalize families with children who have preexisting conditions. By 2014, government regulations for health insurance companies will ensure that they will not be able to deny coverage for anyone with a pre-existing condition.

Until the Affordable Care Act takes effect the federal government has started a mandate that requires every state to offer an insurance pool. Each state has the option to run their program independently or use federal funding. These pools provide health insurance to people with pre-existing conditions at rates comparable to what they would pay for from a private health insurance company. In 2014 these programs will be phased out.

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