Individual Insurance Market Rules in Minnesota
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- Can insurance companies deny me coverage?
Insurance companies can deny you coverage in Minnesota. Insurance companies are not required to sell coverage to everyone who applies. That means they can deny you coverage becaus eo anything they find objectionable in your health history. However, in Minnesota, individual market insurance companies must sell standardized high-risk pool policies to anyone who has a pre-existing condition that makes him/her ineligible for a regular insurance policy.
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- Can insurance companies charge me more than other people for the same policy?
Insurance companies can charge you more than other people for the same policy in Minnesota. If an insurance company chooses to sell you a policy it can charge you more for the same policy if it believes you pose a higher risk of costing it money, including if you have a pre-existing condtition, are older, or are a woman of childbearing age. However, Minnesota uses "health status rate bands" which limit the amount by which premiums can vary due to health status.
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- Can insurance companies exclude coverage of my pre-existing condition?
Insurance companies cannot permanently exclude coverage of your pre-existing condition in Minnesota.Insurance companies cannot permanently exclude from coverage any health problems you disclose, or they find in your medical records, at the time of application by an amendment to the individual health insurance contract (called an “elimination rider”).
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- Can insurance companies make up their own definition of a pre-existing condition?
Insurance companies can only consider something a pre-existing condition if the person actually recieved medical advice, diagnosis, care or treatment for that condition prior to the enrollment in the plan. This is called an "objective standard."
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- Can insurance companies accept my application for coverage and later search my medical records for an excuse to deny me coverage for needed care?
Insurance companies can accept your application for coverage and later serach your medical records for an exuse to deny you coverage for needed care in Minnesota. If you make a claim for health care services during the first 18 months (one and a half years) of coverage, the insurance company can search your medical history dating back 6 months prior to the purchase of your policy looking for evidence that your current health problem was pre-existing. If the insurance company finds any such evidence, it can deny you coverage for the condtion.
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- Can insurance companies pay their doctors incentives to provide me with less care?
Insurance companies cannot pay their doctors incentives to provide you with less care in Minnesota. An insurance company cannot pay health care providers incentives to withhold covered care.
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- Can I appeal an insurance company’s denial of care to an outside entity?
If you are a member of any health plan regulated by the insurance commissioner of the state, you can appeal an insurance company's denial of care to an outside entity in Minnesota. You can file an appeal for any adverse determination to the Commissioner of Health. There is a $25 fee and you must file an appeal within a timeframe established by the health insurer and communicated to the insured.
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- Can I sue my insurance company if it denies medically necessary care that causes me or a loved-one harm?
You can sue your insurance company if it denies medically necessary care that causes you or a loved-one harm in Minnesota. You can sue an insurance company for harm that may have resulted from its denial of coverage or benefits.
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SOURCE: Kaiser Family Foundation State Health Facts, 2007
To learn about all your rights and protections in the individual insurance market, contact the Minnesota Department of Commerce Insurance Gateway.
