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Arizona health insurance   Insurability in Arizona

Qualifying For Arizona Health Insurance     

Individual and Family health insurance is different from Group (Company) insurance in that they can decline and or change rates based on your health at the time of application.  Below we have some common reasons for difficulties in getting approved but first a few quick tips regarding qualifying for coverage.

  • Some situations require time away from the condition in order to qualify.  For simple situations, a 6 month period sign, symptom, and treatment free is a good estimate.  This can also pertain to medication.  

  • It is not uncommon to be declined by one carrier and accepted by another even though the carriers have very similar underwriting requirements.

  • If we are declined by a carrier, we may lose our Short Term option.  If there is an issue, and you have no coverage, we recommend getting Short Term coverage first and then apply for the permanent plan.  Get more info here.

  • Brand name medication are heavily scrutinized these days due to the cost associated with their use.  

  • If you are currently on Cobra, it typically makes sense to apply for coverage as there is no down side.  You can remain on your Cobra if the coverage is not approved.  Cobra is usually quite expensive.

  • The carriers can offer a split approval where one member is not approved but the rest of the family is.

  • The carriers are mainly looking at current/recent and ongoing situations.  We all have a medical history but situations that are stable, from which time has passed, typically do not cause problems.

  • If you are exhausting or losing Cobra (continuation of group coverage) you may be eligible for HIPAA.  Please check with us if this sounds applicable.

    Some common reasons for declination/deferrals of coverage

    • currently pregnant or an expecting father 

    • multiple medications especially brand name

    • recent (last 6 months including physical therapy) injury

    • recent (last 2-3 years) treatment for heart disease, diabetes, cancer, immune system disorders, or any other serious medical condition

    • height/weight outside guideline range

    • multiple conditions/injuries/illnesses

    If you have questions about your preexisting conditions whether listed above or not, please call us at 866/344.8061 or email us to receive personal assistance from a licensed Arizona health agent. We will be able to advise you based on your specific medical history. 

    More information on Enrolling and qualifying for Individual and Famly Arizona health insurance:



    Enrolling in a Individual Family Health Plan
    1.  What is needed to start the process
    2.  How long does it take
    3.  Do I submit payment with the application
    4.  Is there a fee to apply
    5.  Do I need a physical
    6.  How can I expedite this
    7.  Am I locked in for a period of time
    8.  How is payment handled
    9.  Can I change my plan later
    10. Why should I go with you 

    What is needed to start the process

    We basically need the completed health insurance application (download here or have a hard copy sent to you), and the first payment to the carriers for at least one month's worth of premium.  If there are medical records needed, they will request them directly from the doctor.  This completed information can be expedited by faxing (866/394.8320) us a copy of the app and check, and then sending the original in the mail: 
      Walter Jarvis Insurance Services
      PO Box 32268
      Los Angeles, Ca 90032

     Blue Cross has an online application and credit card option as well.  More information on applying for health insurance
           back to top

    How long does it take

    There are two different scenarios.  If the applicant is in good health and there isn't much the health carrier wants to check into, we usually hear back in one to two weeks.  If the volume of applications is running high in underwriting, the time frame can be longer.  If the carrier wants further information on something listed in the application, they will request records directly from the doctor and this can delay the processing time.  It usually adds another 2-4 weeks depending on how quickly the doctor responds back to the request.   back to top

     

    Do I submit payment with the application

    The first month's premium must be submitted with the application.  This can be done with a check made out to the carrier or via credit card (for Blue Cross Blue Shield of Arizona, Blue Shield of Arizona and Health Net).  If the application is not approved, this initial payment will be fully refunded.  back to top

     

    Is there a fee to apply

    There is no fee to apply.  Only the initial month's premium is submitted with the application.  back to top

     

    Is a physical required

    A physical is not required...only the completed application and first months premium.  Blue Shield may require a physical for applicants over the age of 55 who have not had one in the last two years.  back to top

     

    How can I expedite the processing

    Blue Cross Blue Shield of Arizona has an online application which tends to process very quickly.  Otherwise, you can fax your completed application and copy of check (or credit card section) to 866/394.8320 to start the process immediately.  You would then mail the original if paying by check.  The credit card option just requires the faxed copy.  back to top

     

    Am I locked in for a period of time

    No.  The policy can be cancelled or renewed (by payment) month to month.        
                                                                                                  back to top

     

    How is payment handled

    There are a few options for payment with either carrier.
    Billing - Shield monthly, quarterly    Blue Cross bi-monthly, quarterly
    Credit Card Blue Cross allows monthly, bi-monthly, quarterly credit card deduction
    Checking account auto-deduction monthly deduction.   back to top

     

    Can I change my plan later

    Downgrading is easy to do within the same kind of plan such as Share 500 to the Share 1500.  Upgrading is possible if you are in good health as it is subject to underwriting.   back to top

    Why should I go with Walter Jarvis Insurance Services

    We concentrate on health insurance for Arizona

     


    Individual health insurance is insurance you buy on your own, rather than having it provided by your employer.  Please examine your options carefully before declining group coverage or continuation coverage, such as COBRA, that may be available to you.  You should be aware that Arizona companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely.

    If you are in the market for individual health insurance, most insurance companies have online tools to help you find out how much individual health insurance will cost.  If you have a chronic illness or other health condition, it can be hard to buy individual Arizona health insurance.  If you have applied for individual health insurance and been denied, the information below may help you determine why you may have been denied and if that denial was appropriate.

    Medical Underwriting

    When you apply for individual health insurance, the Arizona health insurance company uses a process called medical underwriting to look at your age, sex, and health history to decide whether it will cover you and how much it will cost to provide you coverage.

    Do all health insurance companies have the same underwriting guidelines for offering insurance?

    No.  Each insurance company has its own underwriting guidelines, which are usually not made public.  However, insurance companies marketing and selling individual health insurance policies in Arizona must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance (Insurance Code Section 10113.95 which was added by Assembly Bill 356 in 2005).   We have summarized the information that companies have filed in the questions and answers and chart below.

    • Health conditions that would automatically not be approved;

    • Health conditions that may not be approved;

    • Height and weight standards;

    • Health history, health care service utilization, and lifestyle or behavior that may cause the insurance company to deny insurance, limit the products they offer, or charge more for the coverage.

    What health conditions will cause a health insurance company to automatically refuse or deny my Arizona health application for insurance?  

    There are many medical conditions that may cause an insurance company to automatically deny or not approve your application.  These may include the following:

    • Health problems for which you have not seen a doctor;

    • Health problems that a doctor cannot explain;

    • Health problems for which you have not completed treatment.

    An insurance company may also automatically deny your application for the health conditions below.  There may be other health conditions that are not on this list.

    • AIDS;

    • Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;

    • Cancer, under treatment;

    • Sleep Apnea;

    • Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities;

    • Heart disease;

    • Renal failure or Kidney Dialysis;

    • Diabetes with complications;

    • Cirrhosis;

    • Multiple Sclerosis;

    • Muscular Dystrophy;

    • Systemic Lupus Erythematous;

    • History of transplant;

    • Lymphedema;

    • Current infertility treatment;

    • Hepatitis;

    • Hemochromatosis.

    What will cause an insurance company to offer me insurance at a higher premium rate or limit the products or benefits I can get?

    Insurance companies may offer you insurance at a higher premium and/or limit the products or benefits you can purchase if you had a health problem in the past but you have recovered or you have been without symptoms for some time.  Insurance companies will also do this for minor health problems that you had in the past or may currently have.  Insurance companies argue that these conditions pose a risk that it will cost more for your health claims than if you were completely healthy.  Each application and insurance company is different.  An insurance company may charge a higher premium or limit the products offered for the health conditions below.  There may be other health conditions and time frames that are not on this list.

    • Stroke, after 10 years with no reoccurring problems;

    • Allergies, while testing is in process;

    • Ear infections, controlled with medications;

    • Lyme's disease, without symptoms after one year;

    • Breast Implants (non-silicone);

    • Ringworm;

    • Joint sprain or strain, recovered and no restrictions;

    • Migraine headache, mild and infrequent with no emergency room visits;

    • Mild depression.

    Will a Arizona health insurance company look at my height and weight when I apply for insurance?

    Yes.  Insurance companies usually look at your height and weight when they decide to offer insurance.  They may offer you insurance at a higher premium rate or refuse to insure you if you are overweight or obese.  Some insurance companies use a measurement called the Body Mass Index (BMI) to decide.  If your BMI is above 39, most insurance companies will not offer you insurance.  If your BMI is 30-39, an insurance company may offer you insurance at a higher premium.  If you have health problems because of your weight, such as diabetes or heart disease, an insurance company may refuse to insure you, even if your BMI is under 30.

    Can a health insurance company look at my smoking and drinking history when I apply for insurance?

    Yes.  Insurance companies may look at smoking and drinking history when they decide whether to offer insurance. 

    The following chart summarizes underwriting information that health insurance companies have filed with the Department of Insurance.



    AB 356:  Summary of Underwriting Information filed  re conditions for which no insurance coverage will be offered, application will be denied, or higher premium may be charged or benefit may be limited

     Condition

     Insurance Company Action

    Health problems for   which   you have not seen a doctor

    Automatic decline for some companies  

    Health problems that a doctor can not explain

    Automatic decline for some companies

    Health problems for which you have not completed treatment

    Automatic decline for some companies  

    AIDS

    Automatic decline

    Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process

    Automatic decline

    Cancer, under treatment

    Automatic decline

    Sleep Apnea

    Automatic decline or higher premium will be charged

    Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities

    Automatic decline

    Heart disease

    Automatic decline

    Renal failure or Kidney Dialysis

    Automatic decline

    Diabetes with complications

    Automatic decline

    Cirrhosis

    Automatic decline

    Multiple Sclerosis

    Automatic decline

    Muscular Dystrophy

    Automatic decline

    Systemic Lupus Erythematous

    Automatic decline

    History of transplant

    Automatic decline

    Lymphedema

    Automatic decline or higher premium will be charged

    Current infertility treatment

    Automatic decline

    Hepatitis

    Automatic decline

    Hemochromatosis

    Automatic decline

    Rheumatoid Arthritis

    Automatic decline

    Stroke, after 10 years with no reoccurring problems

    Automatic decline or higher premium will be charged

    Allergies, while testing is in process

    Automatic decline or higher premium will be charged

    Ear infections, controlled with medication

    Higher premium may be charged

    Lyme's disease, without symptoms after one year

    Automatic decline or higher premium will be charged

    Breast Implants (non-silicone)

    Automatic decline or higher premium will be charged

    Ringworm

    Higher premium may be charged

    Joint sprain or strain, recovered and no restrictions

    Higher premium may be charged

    Migraine headache, mild and infrequent with no emergency room visits

    Higher premium may be charged

    Mild depression

    Automatic decline or higher premium may be charged

    Obesity

    Automatic decline or higher premium may be charged

    STD (Sexually Transmitted Disease)

    Automatic decline or higher premium may be charged

     

    Of course, if you have questions, please contact us.  That's what we are here for.

    email:  help@ARIZONAPLANS.COM

 

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