Can I be turned down for health insurance because of my diabetes?

Employer sponsored group health insurance plans are not allowed to turn you down based on your health status. Some employers require newly hired employees to take and pass a physical exam (or to fill out a health questionnaire) before enrolling in health coverage.

Individual health insurance policies, however, are not subject to the same consumer protections. The individual health insurance market in most states is characterized by “medical underwriting.” That is, insurers in this market decide whether to sell coverage (and if so, what benefits to offer and what premium to charge) based on the health status, prior medical history, age, gender, and other characteristics of applicants. Diabetes is a condition for which most medical underwriters will automatically deny coverage. However, this is not true in all states.

For example, in a few states, medical underwriting is illegal. In others, only certain residents must be sold individual health insurance policies. Still other states designate one or more insurance companies (usually Blue Cross Blue Shield) as “insurers of last resort” who cannot turn individuals down for coverage based on their health status. For more information on individual policies in your state, please visit the Georgetown University Health Policy Institute’s Web site for a health insurance consumer guide for your state.

In most states, all private insurers in the individual market can medically underwrite coverage at least some of the time. Many (though not all) of these states establish high-risk pools that offer coverage to certain “uninsurable” individuals whom private insurers turn down.

Additionally, a federal law, called HIPAA, requires private insurers to guarantee coverage to qualified individuals (known as “federally eligible individuals”) who are leaving group health plan coverage and meet certain requirements. For more information about your rights, please refer to your state consumer guide.

The American Diabetes Association

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