; Educate yourself about your health insurance application
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Educate yourself about your health insurance application


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									FOR IMMEDIATE RELEASE                                              For more information, contact:
April 2, 2008                                                                       Bob Hanson
                                                                       Public Information Officer

Commissioner’s Corner-April
By Sandy Praeger
Commissioner of Insurance

Educate yourself about your
health insurance application
TOPEKA, Kan. – Filling out an individual health insurance application can be confusing and
difficult, but filling it out correctly is important. Insurance companies scrutinize these
applications, closely reviewing the information you provide.

People across the United States have had their health insurance rescinded by their companies
because of incomplete or false information. That's why it's vital that you educate yourself about
individual health insurance and your rights as a consumer.

Following are suggestions to keep in mind when you want to secure an individual health care
policy for yourself and your family. Remember, if you are receiving your health insurance
through a group policy with your employer, these rules do not apply.

Overview of a health insurance application
The insurance company will usually request the following:

   •   Common information such as name, address, Social Security number, marital status and
       number of dependents.
   •   Whether any of the applicants have other health insurance coverage in force or are
       covered under Medicaid/Medicare programs.
   •   The date you would like coverage to be effective.
   •   Health information about yourself and other family members desiring coverage.
       Extensive medical and health information will be expected for the applicant and any
       other family member listed on the application. The information requested can vary, so
       pay close attention to the number of years of medical history required and the exact
       health information requested.

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   •     Whether anyone listed on the application has previously been declined health, disability
         or life insurance, or had their health, disability or life insurance canceled or rescinded. If
         you answer “yes” to any of the background health questions on the application, the form
         may ask you to provide the name of the family member, their physician’s information
         and the exact details regarding the dates and nature of their condition.

What is a pre-existing condition?
A pre-existing condition is commonly defined as a physical or mental condition for which
medical advice, a diagnosis, or care or treatment is recommended or received within a certain
period of time before the enrollment date of the policy. The definition of the term might differ
somewhat from insurance company to insurance company. Even if a company approves your
coverage, it might restrict coverage of pre-existing conditions completely or for a specified
period of time.

However, once you are accepted for coverage, the company may only cancel your policy for
nonpayment of premium or for a misstatement of a material fact, such as a omitting a pre-
existing condition from an application. Sometimes pre-existing conditions will cause a claim to
be denied or raise your premium.

The rules that govern pre-existing condition exclusion periods in individual policies vary
between states. Individual health policies may exclude pre-existing conditions from coverage for
as long as 24 months.

Complete disclosure is required before signing
The last part of the application is an agreement that typically states any dishonesty or failure to
disclose requested or material information could result in an approved insurance contract being
terminated. Giving accurate and honest answers will save you possible problems. Sign the health
insurance application only after you have reviewed it carefully to be sure the answers are
complete and accurate.

Health insurance underwriting
Insurance companies will use the medical information obtained on the health insurance
application as well as your age to help determine your premium rates. Occasionally, insurance
companies will need additional information from your physician or another medical provider.

Insurance companies can accept your application and issue the policy as requested, or they can
do one of the following: Issue the policy with full protection but charge a higher premium;
modify the benefits, sometimes by increasing the deductible; exclude a specific medical problem
from coverage by adding an exclusion rider; or decide not to issue you a policy.

Denial of health insurance coverage
Help may be available if you are turned down for individual coverage or find the policy is
approved, but the premiums for the coverage are too high. The state of Kansas has a program, the
Kansas Health Insurance Association (www.khiastatepool.com), that helps provide health
insurance to those denied coverage because of a medical or pre-existing condition. Medicaid (for
low-income and disabled persons), HealthWave and other possible programs are also available.

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Make sure you check with our department regarding health insurance and the options available if
you are denied an individual health insurance policy. Call our Kansas Insurance Department
Consumer Assistance Hotline at 800-432-2484.

More Information
For more tips about choosing health insurance coverage that is right for you and your family, go
to our Web site, www.ksinsurance.org, or www.insureUonline.org.

On our Web site, you can download our free publication Health Insurance in Kansas, which
contains much more information about types of policies and consumer considerations. You can
also call our Consumer Assistance Hotline at the number above to obtain a mailed copy.

The more accurate information you can provide on an application, the better your chances of
successfully obtaining the insurance that covers your health situation.


The Kansas Insurance Department, established in 1871, assists and educates consumers,
regulates and reviews companies and licenses agents selling insurance products in the state.
More about the department is online at www.ksinsurance.org.

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