Insurance Integrity

The individual health insurance market is growing with the proliferation of micro-businesses, entrepreneurs, and outfits no longer offering health coverage to their employees.

These days, the same folk who traded company pension plans for self-managed 401(k)s are now being asked to take on another chore that used to be handled by human resources: shopping, selecting and purchasing private health insurance.

If ya’re purchasing your own health coverage, there are 3 huge issues.

With group policies, health insurance outfits have to cover anybody the company hires. But with individual health plans, carriers have the freedom to cherry-pick consumers.

And sometimes the exclusions or limitations don’t even concern a current condition. If ya’re a gal of child-bearing age, ya could face a large deductible on anything related to maternity coverage. In addition, Consumers buying their own coverage face another challenge that didn’t exist when they were under the group umbrella — being dropped.

Under a group policy, the insurance carrier has to cover everybody in the group. It can raise the rates on the group, but it can’t just drop somebody. With individual insurance, the carrier can do both.

And then there is rescission. Some consumers report that after making claims during or after an sickness, their carriers reviewed their applications, falsely accused them of lying about health issues, and rescinded coverage, claims Flanagan. Not only are the consumers suddenly without insurance, but carriers sometimes send them a bill for any claims that have already been paid.

If ya’re shopping, ya need to know who’s selling. Go to your state insurance department Web site for a list of licensed health insurance outfits and brokers who sell health insurance in your area. The state site will also have info about complaints (including complaint ratios), that paint a picture of which outfits are giving the best service.