A health insurance policy is a contract between the insurance company and the insured plan member. The contract includes two documents, the application and the insurance policy (also called the Evidence of Coverage). It is the application that is reviewed by the insurance company to determine if the applicant meets the eligibility and health requirements of the insurance company with whom they are applying for benefits. Since the application is a part of the contract, an insurance company will usually not process a new application unless it is signed and dated by the applicant or a legal guardian of the applicant. The application must be submitted to the insurance company within a specific amount of time following its completion. There are many parts to most health insurance applications, including the purpose of the application, choice of coverage, billing options, applicant personal information, statement of health, prior coverage information, writing agent information, conditions of enrollment, authorization for medical records and signature and date. The purpose of an application for medical insurance may include new enrollment, request to change health plans or the addition of a new dependent. For choice of coverage, most health insurance carriers offer several different health plan choices that are each listed on the application. Applicants must select from these plan choices, and also select from optional supplemental benefits, such as life insurance or dental insurance. Choosing a specific health plan may also require you to pick from various deductible options that are available for your plan choice. Billing options may include a monthly statement, credit card authorization or automatic bank draft, and the first month's premium is usually required along with a submitted application. The personal information required on an application is used to determine your eligibility based on age, legal resident status and occupation. Your height and weight, primary care physician name, social security number, address and phone number are common questions asked in this section of the application. If you are included a spouse or children on the health plan, their personal information must also be included in this section. The most involved section of any application for medical insurance is the health history questions. It is the answers to these questions that the medical underwriter for the insurance company will review closely to determine if you are a reasonable risk for the insurance company to assume. Just about every medical condition you can imagine is addresses in this section, and you must indicate if you have ever been treated for, or had symptoms, for any of these listed medical conditions. You will also need to disclose any medications you are currently taking, as well as the details of your last office visit. If you have had recent medical care, the insurance company will want to know the dates of the care and the physician or medical facility that delivered this care. Information pertaining to any prior health insurance coverage, including the name of the insurance company, the type of coverage, the policy numbers and date of coverage must also be provided on the application so the insurance company can determined your pre-eisting medical condition waiting periods and your HIPAA eligibility. Finally, your signature guarantees to the insurance company that you have completed the application honestly and also gives the insurance company the authorization to obtain medical records from any or all of your physicians.
Answered: May 03, 2010