 |
Open Enrollment Central |
Deciding on a Plan |
Self-Service Tools and Resources |
Extras for Members |
Support |
About CareFirst
Medical underwriting is a process that insurers use to evaluate information about a person when they apply for health insurance. Several items are considered for this evaluation. First, the applicant is asked to fill out a health questionnaire and the answers are carefully reviewed. To follow, any past insurance claims may be reviewed along with any patient medical history on file, and any medical reports completed and filed by physicians.
Every health condition is assigned a specific point value, based on a pre-determined formula. Coverage is then determined by the number of points that have been calculated per condition and a premium rate is determined for the policy.
In some cases, based on all of the health information the applicant has provided, he or she may be denied health insurance coverage.
Myths of Medical Underwriting
- What are pre-existing conditions?
Pre-existing conditions are any medical condition that existed prior to the applicant's effective date (the date the application was received), even if it has not been officially diagnosed by a health care provider.
- Does every member identified on the application go through the medical underwriting process?
Yes, every member that is identified on the application goes through the medical underwriting process.
- If you have a chronic condition are you automatically rejected during the medical underwriting process?
No, having a chronic condition does not necessarily mean that you are automatically rejected. If the conditions do not amount to an excessive amount of points (please see above for point description), you will be offered coverage.
|
|
