Accident and Health Questions

Group Health: Can my employer change our health insurance carrier and level of benefits during the year?
What happens when my group health coverage ends?

COBRA Benefits: What happens to my group health coverage if leave my employer?; What options do I have if my employer isn't large enough to be affected by COBRA?

Individual Health: Can my health insurance carrier continue to raise my premium rates?
Can health insurance companies deny my application for individual insurance due to a health condition?
What is a preexisting condition?
If I change from one individual health policy to another, can the company impose preexisting condition exclusion on the new policy?

Medicare Supplements: When should I apply for a Medicare supplement policy?
I am not satisfied with the company I currently have my Medicare supplement with. How often can I switch companies?

Group Health

Can my employer change our health insurance carrier and level of benefits during the year?: Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.

What happens when my group health coverage ends?: You can apply for individual health coverage under the federal law Health Insurance Portability and Accountability Act (HIPAA). This typ of policy is issued on a guaranteed issue basis if you meet the qualifying criteria. However, there is no limit on the maximum premium the company can charge. Preexisting conditions are waived.

The Missouri Health Insurance Pool (MHIP) offers individual health coverage for persons who have been turned down in the private market, involuntarily terminated from their health care coverage, being charged more than 300 percent of standard premiums for health insurance, qualify for the federal Health Coverage Tax Credit or are currently enrolled as HIPPA eligibles in plans offered by the state's indvidual insurers and HMOs.

What happens to my group health coverage if leave my employer?: If your employer has more than 20 employees, it is subject to the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) law and entitled to a minimum of 18 months of continuation coverage. Under each of these options, you will have to pay the full premium yourself even if your employer paid part of your premium while you were employed. You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Pension and Welfare Benefits Administraton website or by calling 816-426-5131.
What options do I have if my employer isn't large enough to be affected by COBRA?: If your employer has less than 20 employees, you are entitled to 9 months of continued group health coverage with your employers group plan under Missouri law (376.428 RSMo).

Can my health insurance carrier continue to raise my premium rates?: Yes. Missouri is an open competition state and, as such, we do not have the authority to regulate premiums on most types of health insurance. Our state relies on competition among companies to determine the premium rates. Medicare supplement insurance premiums are subject to some regulatory oversight.
Can health insurance companies deny my application for individual insurance due to a health condition?: Yes, the company has the right to deny coverage for almost any reason on a new application. However, once you are accepted for coverage, your policy can only be terminated for one of two reasons. The company can cancel your policy for failure to pay your premiums in a timely manner or if you misrepresent information on the application or fail to disclose known information, the company may rescind the policy for material misrepresentation.
What is a preexisting condition?: This is normally a physical or mental condition for which medical advice, diagnosis, care or treatment is recommended or received before the effective date of the policy. The definition can vary from policy to policy.
If I change from one individual health policy to another, can the company impose preexisting condition exclusion on the new policy?: Yes.

When should I apply for a Medicare supplement policy?: When you elect coverage under Medicare Part B either due to age or disability, you have a 6-month open enrollment for a Medicare supplement policy, which guarantees you coverage with a plan and company of your choice. You may choose from the 10 standardized plans (A-J). If you do not purchase a plan within your 6-month open enrollment, any company you apply with can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare HMO. Please contact us about these.
I am not satisfied with the company I currently have my Medicare supplement with. How often can I switch companies?: Each year on your Medicare supplement annual anniversary date you have the ability to switch companies as long as you apply for the same plan (A-J) that you currently are enrolled in and you apply for the policy within 30 days before or after your annual anniversary date.

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	Matt Blunt, Governor Linda Bohrer, Acting Director