Questions consumers should ask when shopping for Individual Health Insurance

When selecting an individual policy, these items should be included clearly - in writing - for any individual health insurance policy which you are considering:

• The name of the company writing the policy (not just the marketing name that is used in advertising);
• A list of items and services that the policy will pay for;
• A list of items and services that the policy will not pay for (known as exclusions and limitations);
• Any situations where the policy may not pay for all of your medical care (exceptions, reductions and limitations);
• Any special rules, such as referrals or pre-approval for procedures, that may affect whether the policy pays;
• If you must use certain medical providers, doctors or facilities;
• How long you may have to wait before the policy covers recent health problems (pre-existing condition exclusion period);
• How the policy may be renewed;
• How the policy may be canceled or terminated (by you or by the company);
• What specific steps you may take if you are denied a benefit or coverage to which you believe you are entitled under the policy.

Know what is covered by your policy. Examples: visits to the doctor's office, regular checkups, and visits related to illness or a specific condition, lab work and tests, emergency care.

What exclusions are there on the policy? What is not covered?
Which pre-existing conditions are not covered under this policy?
Will there be an exclusionary rider for your pre-existing medical condition?
Will this policy cover your pre-existing medical condition after you have been covered for a certain period of time?

Your policy should list all items and services that it pays for; and also list all items and services that the individual policy will not pay for (known as exclusions and limitations) and any situations where the policy may not pay for all of your medical care (exceptions, reductions and limitations); For example, the individual policy may exclude coverage for optional surgery such as cosmetic surgery and enhancements, any disease or condition that was diagnosed or treated before the policy was purchased, experimental procedures or alternative health treatments, hearing and vision aids (such as eyeglasses and contacts), and dental treatment. Be sure you understand any limitations or exclusions that are specified in the policy. Many individual policies do not cover in-home care or private nursing. There may be restrictions about hospital stays: some items considered "comfort items" -- but not necessary for recovery -- may be excluded, such as paying for a phone in the hospital room, television rental while hospitalized, or accommodations for a family member to stay with the patient.