Nearly 400,000 Utah residents are living without health insurance. For those who are covered under an employer’s plan or receiving a continuation of benefits after a lay-off under COBRA, insurance carriers are tightening their guidelines for insurance.
Utah requires that individual health insurance policies throughout the state may be medically underwritten. Medically underwriting a health insurance policy provides the insurer an opportunity to review the applicant’s medical history and decide to provide coverage under the terms of the individual health plan; offer modified coverage, with limitations or exclusions of specified benefits; or decline coverage based upon the applicant’s health history.
Based on the results of an underwriting review, your insurance benefits may be modified by the inclusion of an elimination rider which may temporarily or permanently exclude coverage of specific medical conditions. For individuals lacking prior creditable coverage, the health insurance carrier is provided a 6 month “look back,” 12 month exclusionary period, under which the policy may also be modified. Individual premium rates are determined by varying factors and may fluctuate by plus or minus 30 percent of the indexed rate. Individual market insurers that have not met enrollment cap must guarantee issue at least one individual market policy to those that are otherwise not eligible for any other type of health insurance coverage.
Applicants for Utah individual health insurance are evaluated by their age, family size, health status, and if they are able to get alternative health coverage through an employer or public program. An applicant can be turned down for any reason, unless they fit into one of the following categories:
- They are a newborn who’s parent is already covered under the insurer’s policy.
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They are unable to get insurance through their employer and have also been turned down by public programs, such as Medicaid and HIPUtah. In this case, the applicant must be offered a basic coverage plan by the insurer.
In response to HIPPA Group-to-Individual Portability Coverage regulations, Utah requires private insurers to guarantee coverage to HIPPA eligible consumers who meet certain health status qualifications. If they do not, then they will be guaranteed coverage by the state’s program.
Utah’s Premium Partnership for Health Insurance (UPP) helps make health insurance more affordable for working individuals and families who do not currently have health insurance. UPP helps you pay your monthly health insurance premiums through your employer’s health insurance plan. The Primary Care Network (PCN) is a health plan offered by the Utah Department of Health. It covers services administered by a primary care provider.
Applications are only accepted during open enrollment periods, which are held when resources are available to cover more people. The federal government requires PCN to enroll more parents than people without children. Because of this, PCN may schedule separate enrollment times for parents and those without children. To qualify as a parent, you must have children age 18 or younger living at home with you.
PCN covers primary care services:
• Visits to a primary care provider
• Four prescriptions per month
• Dental exams, dental x-rays, cleanings, and fillings
• Immunizations
• Eye exam; no glasses or contacts
• Routine lab services and x-rays
• Emergency room visits
• Emergency medical transportation
• Birth control methods
Utah Individual Health Insurance
Utah does require insurers to offer standardized policies, so you have a lot of choices that can make your individual health insurance coverage more affordable.
In addition to various co-payments and deductibles, you can generally choose between a HMO network and a PPO network. You can also choose between a low, medium, or high deductible. Typical individual health insurance policies cover many basic preventative health services and other benefits like mental health coverage. Utah health insurance laws also require all insurance plans to cover certain benefits, including as breast reconstruction after a mastectomy and treatment of eating disorders.
Utah Group Health Insurance
For purposes of obtaining small group health insurance, the State of Utah defines a small group as a group of employees numbering from 2 to 50. Groups of this size are afforded health insurance coverage on a guarantee issue basis, which provides that no group, or individual employee, may be declined medical insurance coverage as a result of their health status.
During the insurance application process, health insurance carriers may require that each applicant provide a medical history for purposes of determining pre-existing medical conditions. Applicants lacking prior creditable coverage may then be subject to a 6 month look back, 12 month exclusionary period on specified medical conditions. The State of Utah provides that small group premium rates may be medically underwritten. Subject to the group’s overall health, premium rates may vary plus or minus 30 percent of the indexed rate.
Utah Family Health Insurance
Keeping your family healthy is essential to enjoying the best quality of life in Utah. Family health insurance is one of the best ways to protect their health. Normally, family health insurance plans consist on an individual (usually a parent or other adult) adding immediate family members to their policy. Affordable family health insurance in Utah usually costs less than having a separate health insurance policy for each person. Also, a family health insurance plan usually has a higher coverage cap or lower combined deductible than an individual one.
Utah Short Term Health Insurance
Temporary medical circumstances don’t need to leave you or your family uninsured. With short term health insurance, you will be protected if a medical emergency strikes. Affordable short term health insurance in Utah is similar to standard health insurance, with exception to your dates of coverage. For most short term plans, your benefits are available from thirty days to one year. A short term health insurance plan may also be a good investment if there is a short gap in your insurance due to a job loss. Until you’re employed full-time with group health insurance, temporary health insurance can help bridge the gap. Short term health insurance coverage is also suitable for people who are recent college graduates or on strike.
Utah Student Health Insurance
Student insurance is often overlooked until a major medical catastrophe affects the college-bound child in the family. Since minor children are typically covered under a family health insurance policy, many parents assume that their coverage will follow their college-bound child with them to school.
But many colleges and universities require proof of health insurance for students; even if yours does not, student health insurance will probably end up paying for itself. While your college-bound student may be young and healthy now, sudden illness and accidents can happen. The financial impact of an accident or medical complication while uninsured and in college can result in significant medical debt in addition to student loans!
