Individual Alabama Health Insurance Regulations

Medical insurance companies in Alabama are not required to offer standard insurance policies that are regulated by the state. Insurers are able to design their own health insurance plan options and they can choose the deductibles, benefits and coinsurance limits to suit their desires. Certain benefits, like breast cancer screening, are mandated by the state. However, with Alabama individual health insurance plans, the insurance companies are allowed to deny your application based on your present or past health condition. If you suffer from a pre-existing medical condition, the insurance company can proceed with one of three actions, 1) they can deny you health coverage altogether, 2) they can offer you coverage without paying for treatment required for your condition, or 3) they can consent to cover you and your pre-existing condition. The severity of your medical condition and the estimated costs in treating that condition will affect the decision of the insurance company. Even if an insurance company does not ask for an exclusion rider once you are accepted, Alabama law authorizes them to reject pre-existing conditions for up to 24 months, and the insurance company is not required to acknowledge prior creditable coverage. The period that insurance companies recognize previous pre-existing conditions is 5 years.

Small Group Alabama Health Insurance Regulations

If you are an employee that is qualified and you are offered health insurance in Alabama through your employer, the insurance company cannot deny you health coverage based upon your health. Before you are qualified to become a member of the group health insurance plan, your employer may choose to request a waiting period after your hire date. This waiting period must be uniform for every employee working for that company. Also, HMO companies in Alabama can also request a waiting period for any new hires, but the time period cannot be greater than 2 months. Insurance companies may place a refusal on pre-existing medical conditions for a specific period of time. But, the insurance company must recognize any prior health insurance with respect to this waiting period if the previous coverage was continuous and without a lapse of more than 63 days. The Family Medical Leave Act can apply to companies with at least 50 employees and this act protects your health insurance coverage under the group plan for no more than 12 weeks.

COBRA and Continuation of Alabama Health Insurance Coverage

The state of Alabama does not possess a mini-COBRA regulation. However, employers that have at least 20 employees must follow federal COBRA laws. For a period of 18 months, you can remain on your past employer's Alabama group health insurance plan and still get the same level of coverage. The premium amount that was paid by your previous employer is now paid by you, along with a 2% administration fee. In addition, if the insurance company increases the premium on your employer's group plan, you will have to pay those higher rates as well. After you use up your COBRA option, and you are no longer a candidate for Alabama group health insurance, you are eligible for health coverage under the Alabama Medical Insurance Plan and can apply separately for the affordable medical insurance plan of your choice.