|  | Healthcare Industry | Health Insurance

Health Care Insurance Eligibility

Although each insurance company has its own underwriting guidelines, all companies consider basic factors that affect how much it will cost to provide you with health insurance coverage. Some insurers have more stringent underwriting guidelines than others, but most companies will automatically deny your application if you engage in predetermined high-risk behaviors or suffer certain preexisting health conditions.

  1. Medical History

    • An insurance company may deny you health coverage if you have a history of a medical condition such as cancer, cardiovascular disease, diabetes, rheumatoid arthritis, lupus, Parkinson's disease or polycystic kidney disease. Insurers consider applicants with these and other chronic or recurrent diseases uninsurable because of the high cost of treatment. Applicants who have a medical history of asthma, high cholesterol, hypertension, osteoporosis, ulcers and thyroid dysfunction may be accepted by a health plan but are usually charged a higher premium rate or offered less coverage. An insurer normally requests to examine an applicant's medical records and recent lab reports when deciding whether to accept or deny the application. Determining factors generally include severity of a medical condition, how well the disease is controlled with medication and how much time has elapsed since diagnosis or the last active episode of the disease.

    Body Mass Index

    • As a rule, insurance companies include height and weight standards in their underwriting guidelines when rating an applicant's health risks. Insurers often associate being overweight with a higher risk of premature death. If you are overweight or obese with a Body Mass Index above 39, most companies will deny your application for coverage. A BMI between 30 and 39 may get you approved but at a higher premium rate. An insurance company may decline your application even if your BMI is below 30 if you have diabetes or heart disease related to a weight problem.

    Lifestyle Habits

    • Along with your age and employment history, an insurance application normally asks if you smoke, drink alcohol or use recreational drugs. Speeding tickets, DUI arrests or abusing prescription medications are other risk factors that can lead to an insurance company denying your application for health insurance. Omitting or misstating any of the facts could lead to a claim being denied later on if the company approves your application. An insurer can simply state that not all the facts were known at the time you submitted your application. Otherwise, you would not have been approved or enrolled in the health plan.

    Risky Behaviors

    • Insurance companies consider whether an applicant participates in risky behaviors either as part of their employment or as a hobby. Certain occupations may disqualify you for individual health insurance coverage or at minimum come at a high premium cost. Firefighting, commercial fishing, mining, law enforcement and logging are some of the high-risk occupations that may classify you as being uninsurable. Working with explosives, asbestos or other hazardous materials can also get your application denied. Participating in risky hobbies can also significantly increase health insurance premiums. Hobbies that give insurance companies reason for concern include skydiving, white water rafting, deep sea diving, rock climbing, piloting a small aircraft, snowboarding and skiing.

Health Insurance - Related Articles