The health insurance laws and regulations are detailed and difficult to read and understand. Therefore it is important for policyholders to take time to understand their rights under the provisions of their insurance policy.
The Rights of Health Insurance Policyholders
The laws and regulations governing health insurance, vary from state to state. In fact there are no national health insurance companies. All health insurance is sold and managed by companies that work in only one state. While the rules regarding health insurance are state specific, there are some policyholder rights that are observed in every state.
Guaranteed Renewable Rights
If a policyholder has paid their premiums and did not commit fraud on their insurance application, their health insurance coverage cannot be cancelled. This rule is called the “Guaranteed Renewable Provision”. The reason for this provision is that it prevents insurance companies from discontinuing the insurance of individuals who become sick or develop a serious illness.
Adult Dependent Coverage
Under the Affordable Care Act if an insurance company offers dependent coverage they are required to make the coverage available to a dependent child until they attain the age of 26. The policy holder must be the primary source of support for the dependent, but there is no requirement for the dependent to live with the provider or within the provider’s geographical service area.
The Rights of Employees under Employer Sponsored Plans
If an employer offers health insurance they must make it equally available to all of their employees. They do however have the right to exclude part time and seasonal employees. In addition, new employees can be required to complete an affiliation (probation) period before they are allowed to enter into the plan.
Employees that had health insurance coverage under a group health insurance plan and then for some reason lose it have the right to buy an individual plan from the company that provided the group health insurance. This rule protects employees who were laid off or whose employer cancelled their sponsorship of the plan.