Will This Health History Cause Rejection?

[vigo]

26 year old male, Florida resident, looking for individual policy because he is losing coverage under parent's policy. His employer does not offer health insurance benefits. We expect exclusion of pre-existing conditions, but will he be turned down altogether with the following health history?

2012 - endoscopy to diagnose acid reflux issues - no meds prescribed other than OTC
ADHD evaluation (negative), 3 counseling sessions with psychologist for anxiety issues
2010 - visit to PCP to diagnose swollen lymph glands - no problem detected
visit to dermatologist to have small cyst removed on scalp
visit to PCP for complete physical including EKG
2007/2009 - 11 months of counseling sessions with psychologist for anxiety issues - meds taken for 3-4 months only

If he is turned down, is it true that this will stay on his record and he will be unable to get regular coverage (at least until 2014 when ACA provisions begin)? Is it possible for one company to accept him but another to turn him down?

He can get a conversion policy at a much higher premium but it may be worth it if applying for a regular policy would cause rejection and a permanent "record". An agent acquaintance recommended that he not risk it by applying but I wanted to get some opinions here, as well. Thanks

 

[moonlightandmargaritas]

Haven't we seen you here before?

 

[Josh]

Why wouldn't the agent friend help with your situation?

 

[moonlightandmargaritas]

Why wouldn't the agent friend help with your situation?

Maybe he/she figured out (like I posted), a problem case is a lot of trouble for like $10-$11 a month...

 

[Josh]

Maybe he/she figured out (like I posted), a problem case is a lot of trouble for like $10-$11 a month...

I'm leaning towards that or the agent acquaintance just doesn't know health insurance.

 

[VolAgent]

I'm leaning towards that or the agent acquaintance just doesn't know health insurance.

Or the OP doesn't like the answers his is getting.

 

[Crabcake Johnny]

26 year old male, Florida resident, looking for individual policy because he is losing coverage under parent's policy. His employer does not offer health insurance benefits. We expect exclusion of pre-existing conditions, but will he be turned down altogether with the following health history?

2012 - endoscopy to diagnose acid reflux issues - no meds prescribed other than OTC
ADHD evaluation (negative), 3 counseling sessions with psychologist for anxiety issues
2010 - visit to PCP to diagnose swollen lymph glands - no problem detected
visit to dermatologist to have small cyst removed on scalp
visit to PCP for complete physical including EKG
2007/2009 - 11 months of counseling sessions with psychologist for anxiety issues - meds taken for 3-4 months only

Sounds like a case where the carrier would go for medical records. Don't really see a flat decline here but likely exclusions or a rate increase.

If he is turned down, is it true that this will stay on his record and he will be unable to get regular coverage (at least until 2014 when ACA provisions begin)? Is it possible for one company to accept him but another to turn him down?

Yes. One carrier may decline while another accepts.

He can get a conversion policy at a much higher premium but it may be worth it if applying for a regular policy would cause rejection and a permanent "record". An agent acquaintance recommended that he not risk it by applying but I wanted to get some opinions here, as well. Thanks

A decline does not mean he won't get accepted by another carrier, but the agent should contact underwriting for a complete pre-screen so no one's time is wasted. It's worth it to contact underwriting.

 

[DS4]

26 year old male, Florida resident, looking for individual policy because he is losing coverage under parent's policy.

Is the parents policy an employer plan, or, a personal policy?

If employer, son would be eligible for COBRA.
If personal, son could continue as a single insured with same company as parents.

Neither of these would require the submission of a health statement.

 

[vigo]

DS$, the parent's policy is an employer plan (FEHB). Son is eligible for TCC (the fed version of COBRA) as well as a conversion policy. TCC is about 4X as expensive as conversion policy. The conversion policy doesn't require a health statement, either.

Josh, you asked about the agent friend. He's the one who suggested that my son not risk applying because he felt that he'd almost certainly be denied. He didn't mention pre-screening like Crabcake Johnny suggested. I didn't know that was a possibility. I'll ask about it - thanks.

 

[Crabcake Johnny]

The carrier's largest concern will be the thee counseling session for anxiety in 2012. If there's a deal breaker - that'll be it.