|  | Healthcare Industry | Health Insurance

Information on Health Care Insurance for High-Risk People

Health care insurance is offered through employer-sponsored plans, private insurers and government programs. Most plan participants must qualify for insurance coverage. Unfortunately for some people, it is difficult to qualify for health insurance coverage because of current or past health problems. Health care insurance for high-risk people is often more expensive and has more policy restrictions than insurance for people who are not considered high risk.

  1. Description

    • People who are considered high risk for health insurance purposes tend to suffer from health problems. These are commonly referred to as "preexisting conditions." A preexisting condition is a health issue a person has been diagnosed with or treated for prior to obtaining health insurance coverage. If a person had surgery in the past or suffers from a chronic illness such as diabetes or asthma, he is considered high risk for insurance purposes. Pregnancy is also considered a preexisting condition. Some insurance companies may classify a condition that has not been diagnosed previously as preexisting if the person suffering from the condition should have sought treatment for the condition earlier. People with preexisting conditions are considered high risk because if they are accepted by the insurance company, at some point the insurer will have to pay a claim to cover the condition.

    Exclusions

    • Many private insurance companies will accept high risk individuals but exclude existing health conditions. For example, a pregnant woman may obtain individual health insurance for general medical expenses such as preventative care and annual exams, but prenatal care and labor and delivery costs would be excluded from the policy. However, if complications arose from the delivery, the insurance company would usually extend coverage. Exclusions are typically in place for a specified period of time, usually 12 or 24 months. This means any claims that resulted from the preexisting condition during the exclusions period would not be paid.

    Insurance Options

    • High-risk people have few options for health insurance. Employer-sponsored health insurance plans cannot exclude a person because of health status. If a high-risk person has the option to obtain insurance through an employer, this is the least expensive and less restrictive way to be insured. High-risk people who are unemployed or self-employed and cannot qualify for individual insurance because of their health may qualify for state or federal preexisting condition insurance plans. These plans are offered through state or federal Health and Human Service Departments and provide coverage for existing conditions at affordable rates.

    Considerations

    • Once a high-risk person obtains insurance coverage, the policy cannot be canceled by the insurer if the person gets sick. Although high-risk conditions may be excluded from the policy, the insurance company cannot cancel coverage because the person files a claim or needs coverage for an illness unrelated to the preexisting condition.

Health Insurance - Related Articles