FAQs on Individual Health Insurance
Can I afford my own healthcare plan?
Absolutely. Many people think individual health plans are too expensive and beyond their means. But most health insurance companies allow you to choose a plan to suit your personal healthcare needs and your budget.
Can I buy an individual health plan if I already have other health insurance in place?
Yes. Most health insurance companies follow appropriate rules that determine the primary and secondary health plan.
Can I purchase a supplemental accident insurance in conjunction with my individual health insurance plan?
Typically, no. However, most health insurance providers offer benefits for emergency services. Emergency services are not subject to the deductible.
Can I still get Individual and Family health insurance coverage if I, or one of my family members, has a pre-existing condition?
A pre-existing condition is something most people would seek medical advice, diagnosis, care or treatment for. It also means a condition that has resulted in medical expenses, medical treatment, the use of prescription drugs or advice by a physician or other medical professional to receive treatment. Coverage depends on the health insurance provider, but typically most health plans, whether permanent or short-term, have a pre-existing condition clause.
- Permanent plans: If a pre-existing condition existed at any time during the six-month period immediately before the plan’s effective date, then usually health insurance companies will not provide benefits for covered services relating to the pre-existing condition. This is usually true until the subscriber has been enrolled in a plan for twelve months.
- Short-term plans: If a pre-existing condition existed at any time during the 24-month period immediately before a plan’s effective date, then the health insurance company is not likely to provide benefits for covered services relating to the pre-existing condition. This is usually true until the subscriber has been enrolled in a plan for six months.
However, if you have other healthcare coverage prior to their effective date, and did not experience a significant break in coverage, then your prior coverage will be credited toward the nine-month exclusion period. A significant break in coverage is a period of 63 consecutive days during when you did not have any other health coverage.
Please note: The Affordable Care Act eliminates pre-existing condition restrictions and requirements. However, this portion of the law does not take effect until 2014.
I only need coverage for a couple of months - what type of plan would be best for me?
Some insurance companies market “temporary” or “short-term” policies to the unemployed, but any health plan can be cancelled at anytime, so there is no advantage to buying a product with a set time period. Instead, a plan that includes essential coverage at an affordable premium is recommended. There is a typical coinsurance amount and deductible you’ll have to pay for a basic plan, but that’s why the premium is lower.
Who is considered a dependent?
Eligible dependents include the policyholder's spouse and unmarried children up to the age limit, subject to the following:
- Natural children of the policyholder
- Children placed in the policyholder home for the purpose of adoption
- Children for whom the policyholder or spouse is either the legal guardian or has been ordered by a court to provide health coverage
- Stepchildren, if the natural parent is also listed as a dependent of the policyholder
- Disabled dependents*, if they are:
- Unmarried and under the limiting age
- Primarily dependent on the contract holder for support
- Dependents as defined by IRS income tax code
- Covered by the contract holder's current or prior carrier
*Incapacity must have begun before reaching the age limit and must be medically certified by a physician.
It is important to note that children can stay on parents’ plan until age 26. However, this varies from state to state. In Ohio, for example, children can remain on their parent’s plan until 28.
Can I get a policy for my child only?
At this time, Medical Mutual does not offer a child-only policy.
What if the parents are divorced, the mother has custody, but the father wants to buy medical insurance for the child?
The father should complete and sign the application on behalf of his child. If there is more than one child who needs coverage, then the father must complete and sign separate applications for each child.
What if a dependent is pregnant when the application is submitted?
Eligible dependents include not pregnant dependent children under the age of 26. Coverage for the pregnant dependent is not available until her six-week post-delivery exam has been completed. In the case of a Caesarian-Section delivery the dependent will not be eligible until six months after the surgery.
What is an annual deductible?
An annual deductible is a dollar amount that you are responsible for paying each year before Medical Mutual will start to provide benefits.