Individual Health Insurance

Health Insurance: What you need to know about medical records, HIV tests, etc.

When applying for health insurance, an insurance company may ask questions regarding your medical history to help determine coverage eligibility. Medical records from your physician(s) may be requested as part of the underwriting process. Insurance companies rely upon accurate information to make their underwriting decisions. If the insurance company discovers that you did not accurately report your medical history on the application, your policy can be cancelled or rescinded. A health insurance company cannot require you to disclose your HIV status or to take an HIV test as part of the application process (see California Insurance Code [CIC] Section 799.09). However, it can ask if you have received medical treatment for AIDS, AIDS-related complex (ARC), or an immune system disorder other than HIV/AIDS. It may also ask you if you are taking or have taken HIV/AIDS medications. Since HIV infection is not a diagnosis of AIDS or ARC, a health insurer cannot deny health coverage solely because an applicant is HIV positive. If an applicant has been treated for AIDS or ARC, a health insurer can deny coverage based on a preexisting medical condition. CIC Section 10291.5(c)(2) requires that all applications for health insurance (excluding guaranteed issue) prominently display the following notice: "California law prohibits an HIV test from being required or used by health insurance companies as a condition of obtaining health insurance coverage."
If your application for health insurance is declined, you may request the specific reasons for the declination in writing. It is important to remember that an insurance company cannot refuse an application for coverage on the basis of an applicant's race, color, religion, national origin, ancestry, or sexual orientation, nor can they charge higher premiums based on these criteria.