Your Protections When Buying Health Insurance

If you do not have access to employer-sponsored group insurance, you may want to buy an individual health insurance policy from a private health insurance company. 

However, in Minnesota – as in most other states – you have limited guaranteed access to individual health insurance.  Whether you can buy an individual health policy may depend on your health status, the kind of coverage you want to buy, and other circumstances. 

Also, there are some alternatives to individual health insurance such as COBRA and state continuation coverage, conversion coverage, and the Minnesota Comprehensive Health Association (MCHA).

What about coverage for my pre-existing condition?

There are limits on pre-existing condition exclusion periods under individual health plans in Minnesota. Insurers can impose pre-existing condition exclusion periods of up to 12 months. 

A health plan can count as preexisting conditions only those for which you have actually received treatment, medical advice or diagnosis during the 6 months before enrolling in that plan.  No exclusion period can be imposed for pregnancy, genetic information, newborns, or newly adopted children.  Prior coverage must be credited against a preexisting condition exclusion period, provided it was not interrupted by a break of 63 or more days in a row.

In Minnesota, insurers are not allowed to impose elimination riders, which are amendments to the insurance contract that permanently exclude coverage for a health condition, body part, or body system.

When do individual health insurers have to sell me a policy?

In Minnesota, your ability to buy individual health insurance may depend on your health status.  In general, companies that sell individual health insurance in Minnesota are free to turn you down because of your health status and other factors.  When applying for individual health insurance, you may be asked questions about health conditions you have now or had in the past.  Depending on your health status, insurers might refuse to sell you coverage or offer to sell you a policy that has special limitations on what it covers.

Under Minnesota law, newborns (including dependent grandchildren) are automatically covered under the parents’ individual health insurance policy, if the plan covers dependents. However, the insurer may withhold payment of any health benefits for the new dependent until premiums for the new premiums have been paid.

Under Minnesota law, disabled adult children can remain on their parent’s individual health insurance policy after reaching the age at which dependent coverage is usually terminated, if they meet certain requirements.   Your adult child must be incapable of self-sustaining employment by reason of the disability and remain dependent on you for support.  Proof of incapacity must be furnished to the plan within 31 days of the child reaching the age at which dependent coverage would normally end.

What can I be charged for individual health insurance?

If you have an expensive health condition, your individual health insurance premiums may be very high.  Insurers can charge you more because of your health status, age, occupation, or where you live. They cannot charge you more, however, because of your gender. In addition, when you renew your individual coverage, your premiums can increase substantially as you age or if your health declines.

Can my individual health insurance policy be cancelled?

If you have an individual health insurance policy, your coverage cannot be canceled because you get sick. This is called guaranteed renewability.  You have this protection provided that you pay the premiums, do not defraud the company, and, in the case of managed care plans, continue to live in the plan service area.

Some insurance companies sell temporary health insurance policies. Temporary policies are not guaranteed renewable.  They will only cover you for a limited time, such as six months.  If you want to renew coverage under a temporary policy after it expires you will have to reapply and there is no guarantee that coverage will be re-issued at all or at the same price.

Individual Health Insurance Sold by Private Insurers

What will my individual health insurance policy cover?

It depends on what you buy.  Minnesota does not require health insurers in the individual market to sell standardized policies.  Health plans can design different policies and you will have to read and compare them carefully.  However, Minnesota does require all health plans to cover certain benefits – such as mammograms and prostate cancer screening.  Check with the Minnesota Department of Commerce for more information about mandated benefits.

MINNESOTA INDIVIDUAL MEDICAL INSURANCE PROVIDERS