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Small Business Employee Benefits and HR Blog

How Sick Employees Can Get Individual Health Insurance Even If They Have Pre-existing Medical Conditions

sick employees health insuranceIn 45 states, insurance carriers are allowed to reject applications for individual health insurance if the applicant has a preexisting medical condition. If a child of the applicant has a preexisting condition, the child cannot be denied individual health insurance if they are under the age of 19.  

Luckily, the federal and state governments have put special mechanisms in place to ensure that these individuals can purchase an individual health insurance plan.  

If an employee (or a member of an employee's family that is 19 or older) is unable to obtain individual health insurance due to a preexisting medical condition, they will become eligible for individual health insurance in one of the following ways:

  1. If an employee (or a member of an employee's family that is 19 or older) is federally HIPAA-eligible, they can purchase an individual health insurance plan through a mechanism provided by the State

  2. If the employee (or a member of an employee's family that is 19 or older) is eligible for a state's risk pool, they can purchase individual health insurance through the State risk pool

  3. If an employee (or a member of an employee's family that is 19 or older) cannot get health insurance for 6 months, they can purchase an individual health insurance plan through the federal risk pool (PCIP).

When a company cancels their group health insurance plan, employees with pre-existing medical conditions often become federally HIPAA-eligible. 

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