Health Insurance Underwriting Guidelines

Health Insurance Underwriting Guidelines

When you apply for individual health insurance, the health insurance company uses a process called underwriting to look at your age, sex, and health history to decide whether it will cover you and how much it will cost to provide you coverage.

Do all health insurance companies have the same underwriting guidelines for offering insurance?

No. Each insurance company has its own underwriting guidelines, which are usually not made public. However, insurance companies marketing and selling individual health insurance policies in California must file information with the Department of Insurance pertaining to their policies, procedures and underwriting guidelines for offering such insurance (Insurance Code Section 10113.95 which was added by Assembly Bill 356 in 2005). We have summarized the information that companies have filed in the questions and answers and chart below.

* Health conditions that would automatically not be approved;
* Health conditions that may not be approved;
* Height and weight standards;
* Health history, health care service utilization, and lifestyle or behavior that may cause the insurance company to deny insurance, limit the products they offer, or charge more for the coverage.

For more details, go to the page of What health conditions will cause a health insurance company to deny applications?