|Home : Consumers : Health
Click on a topic below to learn more. More information is also available by clicking on the navigation links on the left.
I have been turned down by a health insurance company due to my medical history. Where can I go to get health insurance?
Under the Patient Protection and Affordable Care Act (PPACA), the federal government is required to establish a temporary high-risk health insurance pool program to provide coverage to individuals with preexisting conditions who have been without coverage for at least six months.
This temporary high-risk pool will phase out in 2014 when the health insurance exchanges become active.
- Have no preexisting condition exclusions
- Cover at least 65% of total allowed costs
- Have an out-of-pocket limit no greater than the limit for high deductible health plans ($5,950 for individuals and $11,900 for families)
- Utilize adjusted community rating with maximum variation for age of 4:1
- Have premiums established at a standard rate for a standard population
PPACA also includes a mandate that plans may not impose any preexisting condition exclusions, effective Sept. 23, 2010 for children under age 19 and effective Jan. 1, 2014 for all others.
Additionally, the North Dakota Legislative Assembly has established the Comprehensive Health Association of North Dakota (CHAND). CHAND, which is administered by Blue Cross Blue Shield of North Dakota, provides health insurance coverage for individuals who, because of their medical conditions or history, have been unable to obtain health insurance from other insurers in this state.
A person enrolled in CHAND must pay premiums. By law, the premiums may not exceed 135 percent of the average premium rates charged by the five largest insurers with a similar plan of insurance in force in this state.
For eligibility in CHAND, a person must meet the following requirements:
There is a waiting period after application before coverage is in force for maternity benefits and pre-existing conditions.
- North Dakota resident for at least six months
- Provide written evidence of being rejected for accident and health insurance (or that restrictive riders or pre-existing conditions limitations which substantially reduce coverage were required) by a least one insurance company within six months of the date of application to CHAND.
Application for coverage through CHAND may be obtained through any insurance agent licensed in North Dakota to sell accident and health insurance. General information on CHAND is available from Blue Cross Blue Shield of North Dakota; call 1-800-342-4718.
I will be quitting my job soon and I am worried about losing my health benefits. Is there a way I can continue my health coverage if I pick up the tab?
Terminated employees or those who lose coverage because of reduced work hours are able to buy group coverage for themselves and their families for limited periods of time under both a federal and state law.
If your employer has more than 20 employees, you will generally fall under the federal law, COBRA. COBRA establishes specific criteria for plans, beneficiaries, and events which initiate the coverage. Coverage is only temporary, ranging from 18 to 36 months. The former employee is responsible for the entire premium (the total of what you and your employer contributed). COBRA outlines procedures for employees and family members to elect coverage continuation and for employers and plans to notify beneficiaries.
If your employer has less than 20 employees, you will fall under North Dakota state law. This law identifies the specific rules and regulations to continue your group health coverage. Like COBRA, coverage is only temporary--39 weeks. You must also pay the entire premium to your employer.
back to top
I just found out I am pregnant. I do not have maternity benefits in my insurance policy. Will I or my baby have any coverage at all?
North Dakota statute does not mandate that maternity benefits be available on every policy. Therefore, if you have not purchased maternity benefits on your policy, there will not be coverage for prenatal or postnatal care for the mother. Nor will there be coverage available for the delivery of your baby.
However, there are statutes in place that mandate coverage for complications of pregnancy. All policyholders need to review the definition/provision for "Complication of Pregnancy" in their respective policies.
I have just received notice that my health insurance premium is going up. I have not had any claims. How is my company justified in raising my rate?
Even though you have not had any claims, the theory of insurance involves the pooling of a large number of similar risks, thereby transferring the uncertainty related to the risk from the individual to the insurance company in return for premium. In this way, the insured person pays a small, immediate known loss (the premium) in return for relief of worry from a possible, large, further loss such as a health claim.
Companies requesting rate increases or decreases for health insurance are required to submit supporting decumentation to the North Dakota Insurance Department proving that the rate increase requested is not excessive, inadequate, or unfairly discriminatory. The Department then must analyze the filings to determine if the rate requested is justified.
Companies writing health insurance in North Dakota can revise rates based on the company's "experience" in North Dakota. Experience is the data collected by an insurance company that takes into account premiums collected and claims paid. For every premium dollar received by a health insurance carrier, approximately 75 cents is used to pay for claims and claims processing. The balance of 25 cents goes to pay agents' commissions, general operating expenses, and taxes. If the company is a for-profit organization, state law allows the private company to earn a reasonable profit.
back to top
My new employer says our health insurance plan is a self-insured group. What does that mean?
A self-insured group is one in which an employer serves as their own insurer, paying claims from corporate assets. Many of these employers hire a third-party administrator to manage the payment of claims for their employees.
Self-insured groups are not regulated by the state but by the federal government under ERISA, the Employee Retirement Income Security Act of 1974. Self-insured plans are also exempt from state taxes on insurance premiums.
I received my long-term care policy about two weeks ago. I have decided I don't want to keep it. What do I do now?
If you decide you do not want the policy, you have 30 days after the policy has been delivered to return it to the company and receive a full refund. This is a good time to read the policy over and over again during the "free-look" period. Here's what to do:
- Keep the envelope the policy was mailed in or insist your agent give you a signed delivery receipt.
- Return the policy to the company with a brief letter asking for a refund.
- Send the policy and letter by certified mail.
- Your money should be refunded within a couple of weeks.
I turned 65 in August. I did not sign up for Medicare Part B at the time, but I have decided that I want it. Can I take Part B now without being penalized?
An individual may sign up for Medicare beginning three months prior to the month of his/her birthday, during the month of his/her birthday, and no later than three months after. This gives a beneficiary an initial enrollment period of seven months.
If you did not sign up for Medicare part B during the initial enrollment period, you may sign up during the general enrollment period--Jan. 1 through March 31 of each year. If you enroll at this time, your Part B coverage will not start until the following July 1. A person could lose up to 18 months of coverage for failing to sign up on time.
You could also be charged a 10 percent surcharge on the Part B premium for each 12-month period during which you are eligible but not yet enrolled. This surcharge increases each year as the Medicare premiums increase.
If a person declines Medicare Part B at age 65 because of health insurance coverage through their work or spouse's employment, they may enroll in Part B later without a surcharge added to the premium. The special enrollment period lasts seven months and begins when a person or his/her spouse retires.
back to top
I will be turning 65 in a few weeks. Can you please explain the open enrollment for Medicare supplement (medigap) insurance policies to me?
If you are turning 65, your first priority is to make sure you are enrolled in Medicare Part A and Part B. Contact the nearest Social Security office for information on enrollment procedures. Once you are enrolled in Medicare Part A and Part B, consider whether you may want to purchase additional insurance to supplement your Medicare coverage.
Federal law gives you a six-month open enrollment period to apply for a Medicap insurance policy. The six-month period begins with the first month that you enroll for benefits under Medicare Part B. If you are 65 or older and apply within this six-month period, you cannot be denied Medigap insurance because of health problems. During this period, you have a choice of any of the different Medigap policies sold by any insurer selling Medigap policies in North Dakota. The company cannot deny or condition the isurance, or discriminate in the pricing of a policy because of your medical history, health status, or claims experience. Although some policies do not cover health problems existing at the time of the purchase of the policy, all Medigap policies are required to cover pre-existing conditions after the policy has been in effect for six months.
If you have specific questions about Medicare or Medigap, please contact the State Health Insurance Counseling Program at 1-800-247-0560.
My parents will be turning 65 soon and have already started to look at supplemental policies for Medicare. There are so many policies on the market. How can we be sure they are looking at a Medicare supplement policy?
Look for the words "Medicare Supplement" on the policy. These words identify a medigap policy that meets minimum federal and state standards. There are 10 standardized plans approved for sale in North Dakota. The standardized plans are identified by a letter designation of A through J.
What does portability mean?
After you are accepted by an insurance company for health insurance, the insurer must reduce any time period applicable to a pre-existing condition waiting period for time covered by qualifying previous coverage. The coverage must have been continuous for at least 63 days before the effective date of the new coverage.
back to top