You Have Been Declined for Health Insurance in California, Now What?

If you’re reading this, you’ve probably been turned down for health insurance in the recent past. When you are denied health insurance, it probably has something to do with your medical history. Since California is one of the underwritten states, healthcare companies have the right to deny health insurance. The health insurance company which could refuse and which does not necessarily depend on the risk assessment using actuarial tables. Each time you complete an individual health coverage request and answer yes to any of the medical questions, your request may be reviewed manually by one of the underwriters. It is a person who is responsible for reviewing the request using actuarial tables. Actuarial tables are statistics compiled by insurance companies, hospitals, physicians, and researchers that predict the cost of insuring someone with a specific medical history.

Some states like New York, New Jersey and Washington require insurers to insure everyone. These three states have no medical underwriting and everyone is automatically approved for health coverage. In order to insure everyone with the medical history, the insurance companies increase the rates to the point where it becomes inaccessible to most people. What keeps average monthly premiums low is the low uptake of healthcare. If there are more people with high medical insurance usage with a specific health insurance company, they need to increase rates for everyone in order to keep up with payment of medical claims. It is also causing people who do not use health insurance to abandon health insurance altogether while still raising rates. This leaves insurers no choice but to increase rates. New York, New Jersey, and Washington have the highest premiums for medical coverage, and many families find health care out of reach.

In California, if you’ve been denied health coverage, you have options. If you are unemployed or currently in low income, you may be eligible for medical care and if you have children they may be eligible for a program called Healthy Families. Most states, including California, have high-risk pools designed for people who have been denied individual health insurance. In California, this program is called MRMIP. A simple quick Internet search will guide you to a government website. MRMIP is a government-run program and your major medical insurers participate in it. There is a good chance that you can keep the same health insurance company if you are already used to it. The MRMIP program has limits and there may be a waiting period.

One of the best options for getting the most coverage for your money is a group plan. In the State of California, all group plans must be guaranteed by law. This means that there is no medical underwriting. This option requires more work on your part. Insurance companies won’t just let you set up a group plan if you’ve been turned down for individual health insurance. Since insurance companies are required to insure everyone who is part of the group state, insurance companies must have rules when it comes to setting up a group plan. Some of the basic requirements vary from insurance company to insurance company.

The best way to find out is to talk to an insurance broker. The bottom line that insurance companies are looking for is that you must have a reason for starting a group plan other than getting medical insurance. It’s illegal to start a group plan just to have health insurance. It means you have to have a business and it could be anything. To have a group plan, you obviously need to have more than yourself. It takes at least two people to start a group plan. Everyone who will benefit from the group plan must either own the business or be on the payroll. Some insurance companies require a DE-6 form or six weeks payroll records. If everyone is an owner, then you will need to provide proof of ownership showing all of the people who will be on a collective plan as the owner. It might not be straightforward, but it’s definitely doable and well worth it if you don’t have any coverage and can’t get it on your own.

It’s always easier to blame the insurance company for denying you health coverage. If you’ve been turned down and are looking for health insurance, you just need to be more proactive to get your coverage. Once you work with a broker to meet the requirements of setting up a group plan, it’s yours forever and no one can take that coverage away from you unless you stop paying for it.