Laws Regarding Disclosure of Medical History When Applying for Health Insurance

The laws surrounding health insurance in the United States are complex. The relationships between the patient, insurance company, and doctor are covered by common law, case law and statutory law. Insurance companies ask potential clients to complete detailed application forms. Failure to answer the questions fully or omitting relevant health information can result in the insurance company using this as a disclaimer. In extreme cases, some insurance companies have even instigated proceedings against clients for fraudulent claims.

Information

• Information must be accurate and stored correctly.

  The Fair Credit Reporting Act, (FCRA) imposes a duty on insurance companies and all who deal with patients' records. According to this law, privacy, accuracy and fairness must be maintained when recording information on patients and passing this on to other agencies. Insurance companies must guarantee information gathered from a credit recording agency (CRAs) is accurate and that decisions to deny payment are not based on information from CRAs

HIPAA

• The Health Insurance Portability and Accountability Act is an important piece of legislation on the handling of patients' health information. The Privacy Rule, a part of this legislation imposes rules and limits on who can see health information. The Security Rule imposes regulations on how this information is stored.

Other Disclosures

• One of the biggest worries many people have when applying for medical insurance is what to do about pre-existing health conditions. It is important to disclose these, though there may be a time limit on what you are asked to mention. Sometimes a chronic or pre-existing condition will affect the application. The insurance company may decline the application or impose higher premiums. An applicant's best course of action may be to apply to a group insurance scheme via their employer.