Questions & Answers
(For those who don't get insurance at work)
Since I don't get insurance at work, I applied directly to an insurance company and was denied because of my weight. Can they do that?
A: Yes, as long as you are age 19 or older. More than 20 percent of people who apply directly to an insurance company for an individual health plan get rejected because of medical conditions. It could be for a serious medical condition or because of an expensive prescription drug, or because the company anticipates problems in the future based on something in your medical history. Companies have their own height and weight charts and might turn you down based on your weight. You won't be able to buy a policy if you are pregnant.
However, Oregon has a program for people who are turned down for coverage. It's called the Oregon Medical Insurance Pool (OMIP). The program is not based on income. Learn more at: http://www.omip.state.or.us/
Children under age 19 cannot be denied coverage because of pre-existing conditions.
A: When applying for an individual health plan, the application will request disclosure of all health treatments and conditions over the past five years. If you are age 19 or older this is to determine whether to insure you at all. Additionally, the insurance company has the right to request and review medical records from your physicians, even if they are more than five years old.
It's important to fill out the application accurately and truthfully. If you commit fraud or intentionally misrepresent a material fact on an application, the company could rescind your policy and you would have to pay any medical bills you accumulated during the time you thought you had insurance. In other words, it would be the same as though you never had coverage.
A: If you have an individual health plan, moving into a new age bracket increases your premium on top of medical cost inflation. Medical costs often increase by double-digit numbers every year due to new medical technologies, costly prescription drugs, an aging population, and treatment for chronic conditions such as heart disease and complications of diabetes. Insurance companies set premiums to cover these costs. In Oregon, about 90 cents of every dollar paid in premiums goes to pay medical claims. The Insurance Division reviews and must approve the rates for small employers with 2-50 employees, for people who get insurance on their own through individual plans and for consumers with portability plans. We do not review rates for larger employers.
Citizens not only have the ability to view rate requests, but also to provide comment. These comments are posted on this website and will be part of the review of the proposed rate. Visit http://www.oregonhealthrates.org/ for more information.
A: No. Individual health plan rates cannot be based on your health. Individuals of the same age, and of either sex, pay the same rate regardless of health. Rates may be increased if all policies are increased at the same time. Your increase would be the same as others in your age bracket who have the same policy and same deductible.
A: Your policy cannot be cancelled or non-renewed as long as you pay your premium on time. However, due to changing conditions, insurance companies may cancel all policies and replace them with new policies. In such cases the company must offer you a policy that most closely resembles your old policy, selected from one of their new available policies. Also, insurance companies may stop doing business in Oregon if they follow certain rules. In these rare instances, you would need to apply for new insurance with a different company. A company may also discontinue or cancel your coverage for fraud.