Private Health Care Coverage

Who is Eligible for Private Health Care Coverage?

Whether you'll qualify for private health care coverage often depends on how you obtain it.

When an individual applies for private health care coverage, the company conducts an investigation that will include medical history and the existence of any current conditions, a process called underwriting. Depending on the outcome of the underwriting process, the coverage will either be issued, issued at a higher premium, issued with certain medical conditions excluded, or declined. If your child already has JA, for instance, it may be difficult or impossible to obtain private health care coverage.

Others get coverage through their employer, with the employer typically paying for part or all of the monthly premium. This is often called group coverage. Insurance purchased as part of a larger group, such as a group of employees, is usually less expensive than insurance purchased as an individual or as a single family.

Federal and state laws that govern private insurance provided through an employer differ from those that govern private insurance purchased directly by an individual. Health insurance obtained through employers with fifteen or more employees is governed by a federal law called the Employee Retirement Income Security Act (ERISA). In many cases, coverage obtained through an employer may not require any underwriting and benefits are provided regardless of the employees' or their families’ health conditions. Under another federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), having coverage through a qualified employer means you may be able to get new coverage if you change or lose your job without regard to past or current medical conditions. In addition, you may be entitled to coverage after you leave employment even if you don't get another job. "COBRA" benefits (these were created under the Consolidated Omnibus Budget Reconciliation Act of 1996) are available to ex-employees for a period of 18 months so long as they pay for all the premiums. Check with your employer to determine whether you have rights under HIPAA or COBRA.