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Information on Obtaining Kentucky Individual Health Plans

Obtaining Medical Records

To ensure you do not inadvertently fail to disclose material information, you should retrieve all of your medical records. Some physicians might ask you to send your request in writing. Others may also charge a fee for reproducing your medical records. As a general rule, it is a good idea to request a copy of your files each time you switch doctors.

What is a Pre-existing Condition?

A pre-existing condition is a physical or mental condition for which medical advice, diagnosis, care or treatment was recommended or received within six months of the date the company receives your substantially complete application. Even if an insurance company approves your coverage, it might restrict coverage of pre-existing conditions completely or for a twelve-month period.

However, once you are accepted for coverage, the company may only cancel your policy for nonpayment of premium or for a deliberate falsification of a material fact, such as omitting a pre-existing condition from an application. Sometimes pre-existing conditions will cause a claim to be denied.

Complete Disclosure is Required Before Signing the Application!

The last part of the application is an agreement that typically states any misrepresentation or failure to disclose requested or material information could result in an approved insurance contract being terminated. Giving accurate and honest answers will save you possible problems. Sign the health insurance application only after you have reviewed it carefully to be sure the answers are complete and accurate.

Health Insurance Underwriting

Insurance companies will use the medical information as well as other information obtained on the health benefit plan application to determine your premium rates. Occasionally, insurance companies will need additional information from your physician or another medical provider.

Please note that Kentucky is not a guarantee-issue state with regard to individual health benefit plans. This simply means that insurance companies do not have to write you a policy if you do not meet their underwriting guidelines.