Individual Health Plans

"SevenHills Benefit Partners excels at finding the right benefits program to meet our needs. First, they take the time to truly understand our specific situation and then educate us on the pros and cons of each potential solution. We rely and trust their recommendation and advice. But the real value is the service SevenHills Benefit Partners provides after the sale. It is truly value-added."

David Rothschiller
Executive Director
St. Paul Heart Clinic, P.A.

Independence Service Guidance

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FAQ's

Frequently Asked Questions about Individual Health Insurance

Click on the question below to find the answer!

What is a deductible? What is Co-insurance?

Can I open a Health Savings Account (HSA) with these plans?

I need insurance now! What should I do?

When can I enroll?

When will my effective date be?

Do I have to submit payment with the application? When will my check be cashed (or card run)?

Can I apply to more than one carrier?

Isn’t individual insurance more expensive than group insurance?

Can I be turned down for individual coverage?

What if I am turned down?

Can I be declined for smoking? Drinking?

I have *blank*, will I be turned down?

What if I am pregnant or want to become pregnant?

I’m fairly healthy but I have a surgery coming up in a few weeks, will I be approved?

I haven’t had insurance for some time, will that affect my policy?

Is my plan portable?

I’m not sure I can afford this coverage, what should I do?

What is a deductible? What is Co-insurance?
-A deductible is the amount of money that you will have to pay before the insurance company starts paying. Deductibles are used to help control consumer spending because you are forced to use your own money for a certain amount of your care. Some plans have preventative benefits as well as other features that apply before the deductible is reached.
-Co-insurance is the amount that the insurance company will pay until you have reached your out-of-pocket maximum (OOP). Ex: Lets say you have a $1,000 dollar deductible with 80% coinsurance and a $2,000 OOP. You will pay the first $1,000 of your care and then the insurance company will pay 80% of your expenses until you have paid $2,000 total.

Can I open a Health Savings Account (HSA) with these plans?
-Not every plan is HSA qualified. Make sure you are signing up for the appropriate plan if you want to open a HSA.

I need insurance now! What should I do?
-If you need insurance now, sign up for a temporary plan. It will cover catastrophic claims only but is very cheap and a solid way to keep your self protected for a month or two. You are allowed to be on this coverage for 365 days out of any 555 day period.

When can I enroll?
-Unlike group insurance plans there are no open enrollment periods so you can enroll whenever you like. However, because these plans are medically underwritten it can take up to 4-6 weeks to be approved for coverage. It is always a good idea to plan ahead when enrolling for individual coverage. If you need coverage immediately there are temporary plans that require almost no underwriting and can be in force the next day if necessary.

When will my effective date be?
-Some carriers allow you to request an effective date and some will give you some choices after you are approved. It is best to plan ahead to prevent any gaps in coverage, or use temporary insurance as a filler between plans.

Do I have to submit payment with the application? When will my check be cashed (or card run)?
-Yes. All carriers require a payment of the first month’s premium with the application. Some carriers will cash your check right away while others will hold onto it and cash it when you are approved. If you are approved and decide you do not want coverage you can simply request your money back. If you are declined the company will refund you your money.

Can I apply to more than one carrier?
-Yes, apply to as many as you like. You will have to submit a check to each carrier but will get your money back on the one(s) you decide not to go with.

Isn’t individual insurance more expensive than group insurance?
-Actually no! A group plan gets its rates by spreading risk across all the members of the group. If one member has a large claim then the whole group can suffer the consequences. With individual plans your risk is spread across thousands of members of the plan, therefore if one person has a large claim it will do little to affect your rates.

Can I be turned down for individual coverage?
-Yes. Individual plans are medically underwritten. Each carrier has their own guidelines as to which medical conditions are acceptable risks. Common declines are diabetes, poor height to weight ratio, recent history of cancer, recent DUI/DWI, and so on. If you have a specific question please call or fill out our contact form and we would be glad to help you find a carrier that might approve you.

What if I am turned down?
-If you are turned down for coverage and live in the state of Minnesota you are eligible for the Minnesota Comprehensive Health Association (MCHA). MCHA was founded in 1976 to be a source of insurance for people with pre-existing conditions that could not get insurance elsewhere. It can cost up to 25% more than other insurance but is a very solid plan with the largest network in the state of Minnesota. If you are a Wisconsin resident you can turn to the Health Insurance Risk Sharing Plan (HIRSP).

Can I be declined for smoking? Drinking?
-You cannot be declined simply for smoking, though you will have to pay a higher rate than non-smokers. If you have a history of alcohol treatment you could be declined or have increased rates.

I have *blank*, will I be turned down?
-There are just too many specifics involved with underwriting to answer this question completely. Send us an email or fill out the contact form and we’ll contact the carriers to help you decide which plan best suits you.

What if I am pregnant or want to become pregnant?
-Pregnancy is an automatic decline with individual carriers. You will be eligible for MCHA and should enroll right away. Even If you are planning to become pregnant or taking any sort of fertility medications, you will be turned down for coverage. Each carrier has a 12 to 18 month exclusionary period for the delivery of a child. If you become pregnant and the delivery will fall during the first 12 or 18 months the insurance carrier will not cover the delivery. It is important to be absolutely aware of this before enrolling in a plan.

I’m fairly healthy but I have a surgery coming up in a few weeks, will I be approved?
-Probably not. You may be asked to reapply after the surgery. You would be eligible for MCHA but if you have not been insured you will have a 6 month pre-existing condition limitation.

I haven’t had insurance for some time, will that affect my policy?
-Individual plans come with a pre-existing condition limitation that can last for the first 6 to 18 months of your policy. This means that any existing medical issues that you have had for the past 6 months will not be covered for up to 18 months. However if you have not had more than a 63 day break in coverage, the time that you have been covered will count against the exclusionary period.

Is my plan portable?
-Yes. You own your plan and can take it wherever you go. If you change jobs it will not affect your coverage.

I’m not sure I can afford this coverage, what should I do?
-We have some resources that may be able to determine of you are eligible for a state sponsored plan. Please contact us and we may be able to help you. For a preliminary screening go to Bridge to Benefits.

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