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Health Reform 101 - Can you be denied coverage after January 1, 2014?

August 23, 2013


For Immediate Release:

SAINT PAUL, MN – In addition to expanded benefits sets that will be required in all plans sold during Open Enrollment beginning October 1, 2013, health insurance companies can no longer deny coverage based on past or current health issues.  The Minnesota Department of Commerce is a trusted resource to provide Minnesotans with the health insurance information they need to understand upcoming changes to help make the important decisions for themselves and their families.

What does this mean for me?
Starting January 1, 2014, no health insurance company can turn you down for coverage or limit your coverage because you had a previous illness or injury (or “pre-existing condition”). This is called guaranteed issue.

Insurance companies cannot discriminate against anyone with a pre-existing condition when they offer a health plan. In other words, they cannot discourage you from buying a plan if you are sick or disabled.

How will the price of my health care policy be determined?
Companies cannot charge you more for your health plan if you have a pre-existing condition. The amount you pay for your premium each month can only vary based on the following factors:

  1. Your age (and the age of your family members), 
  2. Where you live, and 
  3. Whether you smoke.  

The Commerce Department is charged with reviewing all rates to evaluate all proposed health insurance rates and rate increases to ensure that consumers are paying premiums that reflect the value of their health plan.  When the rates are under review for individual and small group health insurance plans, they are “community rated.”  This means that rates are determined by the cost of everyone in the community – not solely on the health of the consumer purchasing the plan.

For more information on Minnesota's rate review process, what factors go into a rate filing, and the essential health benefits included in new policies. The Commerce Department reminds consumers that the cost you pay may vary under different policies. When shopping for a new plan, consumers will want to consider the deductible and the copay or coinsurance you would pay when you use your health care, as well as the premium you pay each month.

Visit the Commerce Department's website for more information about changes in health insurance that will be available in plans effective on January 1, 2014. 

The Minnesota Department of Commerce is here to help.
Call our Consumer Response Team at 651-539-1600 or toll-free at 1-800-657-3602 (in Greater Minnesota) if you have any questions about your insurance or if you believe you have been a victim of a scam or fraud.