Utah Medical Insurance

In Utah, approximately 85% of the state's more than 2.5 million people have medical insurance . In fact, medical insurance is easily the most important type of coverage for anyone to carry. It provides protection against illness and injury that can be devastating to your finances as well as your health. Before you start shopping around for medical insurance, you should be aware of the type of healthcare plan your family needs and how much you can afford to pay. Then you need to learn about the different options and guidelines in your state.

Regulations For Individual Medical Insurance

The Utah Insurance Department is the regulatory body which governs private health insurance companies working in the state. Each company must abide by laws set by them in order to sell family and individual medical insurance. The department allows medically underwritten policies in the state, which means an insurer can make a decision regarding insuring an individual by analyzing medical history information. Exclusions, limitations, modification of coverage or denial of coverage are based on underwriting. A rider can also be added to a policy to exclude coverage for certain pre-existing medical conditions on a temporary or permanent basis.

If an applicant for medical insurance is missing creditable prior insurance coverage, an insurer can go 6 months back into that person's medical history and impose a 1 year long exclusion on the policy. In addition, changes are allowed to be made to the policy during that 1 year period.

Risk factors will help the insurer determine rates for each applicant. However, the state limits the amount an insurer can charge to higher risk individuals to no more than 30 percent above the indexed rate. Companies that still have not exceeded their enrollment cap are required to guarantee issue a minimum of one individual policy to a customer who would otherwise not be eligible for any coverage.

Medical Insurance for Small Groups

Utah defines a small group as being between 2 and 50 for the purposes of medical insurance. Such groups are eligible for guarantee issue medical insurance coverage. With this type of policy, no employee in the group can be refused coverage based on their health status. However, when applying for coverage, the insurer can request medical histories from each member of the group. If there is a member who does not have creditable prior coverage, he or she can have their medical history for the last 6 months checked and a 1 year exclusion period for certain conditions applied. When the insurer is setting the group rate, the state restricts it to 30 percent above or below the indexed rate.

Continuation Coverage and COBRA

Federally regulated COBRA ensures that members of groups with 20 or more people have the right to continue their coverage following termination of their employment. This act allows 18 months of continuance under most circumstances and up to 36 months in specific cases. Utah has filled in the gap left by COBRA and created a mini-COBRA plan for groups that are too small to meet the requirements of the federal plan. Mini-COBRA allows for 6 months continuation coverage and the member has 30 days to activate it from the date of termination. The beneficiary must pay the employer's portion, the employee's portion and an administration fee of 2%.