FAQs: Individual Health Insurance
- Can an insurance company turn me down for individual health insurance coverage? If a company can turn me down, how can I obtain health insurance coverage?
Yes, you can be turned down. The South Carolina Department of Insurance has no jurisdiction over the underwriting decisions of an insurance company; therefore, we can't require they insure you.
If you are turned down for coverage, you can get coverage through the South Carolina Health Insurance Pool (SCHIP). Contact SCHIP at 1-800-868-2500, ext. 46401.
- Is there assistance available other than the South Carolina Health Insurance Pool (SCHIP)?
There are many programs available through the federal or state government to assist with the high cost of health care and health insurance. You should contact the Department of Health and Human Services for information about Medicare (including the new prescription drug program which provides many subsidies) and your elibility for Medicaid (for low-income and disabled persons). In addition, the federal governement provides tax credits for certain workers who have lost their job because of federal trade agreements or whose pension program has failed.
- 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 the company cannot cancel your policy except for non-payment of premium.
- What is a pre-existing 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.
- I have an exclusionary rider on my individual health policy. How long can the insurance company keep it on my policy?
The rider will remain in effect for the length of time specified in the terms of the rider. If there is no time limitation specified, it will remain in effect for the duration of the policy unless the insurance company agrees to remove it.
- Why do my health insurance premiums go up? I have not been sick or presented any claims to my insurance company.
Only rate increases by licensed insurance companies in this state for individual policies must be filed with our Department. The filings are reviewed very carefully to make sure that the claims experience and expenses warrant the increase. Please note that this Department does not regulate group rates. Although an Association policy is underwritten on an individual basis, it is group insurance, and the rates are not subject to our review.
- A dependent child on state continuation due to reaching the limiting age of the policy gave birth to a baby during that six-month period. Is the company responsible for offering state continuation to the child up to the end of the mother's six-month period?
Research indicates that coverage for the newborn would not be required by S.C. statute in this instance.