Our Health Insurance Resources And FAQ Page:
What is individual health insurance?
Individual health insurance is coverage that a person buys independently. It can be sold to a single individual, to a parent and dependent children, or to a family. Nationally, most Americans get their health insurance through an employer or through a government program, but a growing percentage of the population purchases private health coverage on an individual basis. In New Hampshire, the Department of Insurance regulates how individual policies may be marketed and sold within the state.
How do I buy individual health insurance coverage?
In New Hampshire, individual health insurance coverage can be purchased through licensed health insurance salespeople also known as agents or brokers. These agents and brokers are trained in and understand the various insurance plans they represent, and they can help you find the coverage that best suits your individual needs. (To obtain a quote for health insurance from a New Hampshire-licensed health insurance agent, click here and then simply fill out our form.)
Is individual insurance different from group insurance?
Individual health insurance is very different then group health insurance. Group health insurance is typically offered through a (large) employer. In New Hampshire, the laws mandating what types of services must be included in individual policies are different than those required in group plans. Some benefits that are standard in a group policy, like maternity coverage, may not be included in an individual plan. Sometimes individual health insurance consumers will have the option to pay extra for coverage of additional services like maternity coverage through optional insurance "riders." For most consumers that buy individual health insurance don't have the benefit of an employer subsidizing a portion of their premium. This is why the cost of coverage is often a major consideration. Consequently, the benefits included in individual policies are often simpler than in group plans, while the deductibles (the amount you have to pay before insurance benefits begin) and cost-sharing (the fees you pay directly to medical providers at the time of service) are typically higher than those in a group plan.
How are premium rates determined?
In New Hampshire, when you apply for individual health insurance coverage, you are asked to provide health information about yourself and any family members to be covered. When determining rates, insurance companies use the medical information on these applications, as well as information on the applicant's age and where they reside (determined by postal zip code.) Sometimes the insurance companies will request additional information from an applicant's physician or ask the applicants for clarification. As a rule, individual health insurance companies are much more limited than group insurance companies in their ability to spread risk. In New Hampshire, a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them "uninsurable." If the insurance company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively (i.e. the assumption relative to the missing information will be negative rather than positive.)
Are health insurance companies required to issue individual policies to anyone who applies in New Hampshire?
No. Unlike in the neighboring states like Maine and Massachusetts, where health insurance is a "guaranteed issue" item, in New Hampshire individual health insurance is "fully underwritten." What this means is an insurance company that issues individual coverage underwrites the applications prior to the policy being issued. Underwriting is based on many things including (but not limited to) age, health status, occupation, and certain hobbies. Consequently, in New Hampshire a company may (1) issue the policy as you applied for it; (2) issue the policy with stipulated exclusions either for a limited or unlimited period of time; (3) issue the policy with an added premium; or (4) decline to issue you the policy.
NOTE: By law, if a policy is issued other than as you applied for it, the company must provide you with their reason for offering exclusions or a declination, upon your request.
If I am declined for an individual health insurance policy and do not have access to a group plan (i.e. I am self-employed, unemployed or retired), how do I get health insurance coverage for myself and/or my family?
If you've been declined for health insurance, the first thing you should do is find out why, and make sure that you were not declined in error. If you determine that you were legally declined coverage, and you are not eligible for Medicare or Medicaid, you have a couple of options:
1. Open Enrollment Period for "Groups of One." New Hampshire law (RSA 420-G:8 I-a.) allows health insurance plans to enroll individuals into certain plans as a "group of one," on a "guaranteed issue" basis, during the months of March and September each year.
2. The New Hampshire Health Plan (NHHP). NHHP is a state high risk pool established to provide health insurance to NH residents who a.) Are declined coverage through the private market, b.) Have a pre-qualifying condition or c.) Are otherwise eligible. The NHHP is intended generally to be the insurer of last resort for New Hampshire residents. Applicants are encouraged to seek coverage from private insurance companies before contacting the NHHP. NHHP also provides health insurance for individuals who are entitled for certain Trade Adjustment Act (TAA) or Pension Benefit Guaranty Corporation (PBGC) benefits. For these individuals, premiums may be payable through the federal health care tax credit program. To determine if you are eligible for the NHHP, go to www.nhhealthplan.org for more information.
3. New Hampshire Healthy Kids (NHHK). New Hampshire Healthy Kids Corporation (NHHK) was first established by special legislative act in 1993. Today NHHK provides access to free and low-cost health coverage to uninsured New Hampshire children of families who meet its income guidelines. (The NHHK also provides families at higher income levels with the opportunity to buy in to the program.) NHHK maintains contracts with Anthem BC/BS and Northeast Delta Dental to provide medical and dental insurance to children who qualify for the Title XXI program. These contracts encompass financial discounts negotiated by NHHK with the State's hospitals and hundreds of health care providers in order to keep the cost of coverage low. To determine if your children are eligible for the NHHK, go to www.nhhealthykids.com for more information.
Can I return my policy if I am not satisfied with it?
When a policy is issued to you, by law you have a "free look" period of no less than ten (10) days to review the policy and confirm that it meets your needs. If you are not satisfied with the policy, you may return it within the 10-day "free look" period and request a full refund of the premium (if any) paid when the application was submitted. To avoid any delay or confusion, if you decide you do not want the policy, you should return the policy directly to the company by certified mail within the "free look" period.
What is a "deductible" and how does it work?
A deductible is the amount of covered expenses you must pay before the insurance company will pay for any of the covered medical expenses. Be sure you understand exactly how the deductible works before buying any policy. There are a number of ways deductibles may be administered by the company:
Individual health insurance is coverage that a person buys independently. It can be sold to a single individual, to a parent and dependent children, or to a family. Nationally, most Americans get their health insurance through an employer or through a government program, but a growing percentage of the population purchases private health coverage on an individual basis. In New Hampshire, the Department of Insurance regulates how individual policies may be marketed and sold within the state.
How do I buy individual health insurance coverage?
In New Hampshire, individual health insurance coverage can be purchased through licensed health insurance salespeople also known as agents or brokers. These agents and brokers are trained in and understand the various insurance plans they represent, and they can help you find the coverage that best suits your individual needs. (To obtain a quote for health insurance from a New Hampshire-licensed health insurance agent, click here and then simply fill out our form.)
Is individual insurance different from group insurance?
Individual health insurance is very different then group health insurance. Group health insurance is typically offered through a (large) employer. In New Hampshire, the laws mandating what types of services must be included in individual policies are different than those required in group plans. Some benefits that are standard in a group policy, like maternity coverage, may not be included in an individual plan. Sometimes individual health insurance consumers will have the option to pay extra for coverage of additional services like maternity coverage through optional insurance "riders." For most consumers that buy individual health insurance don't have the benefit of an employer subsidizing a portion of their premium. This is why the cost of coverage is often a major consideration. Consequently, the benefits included in individual policies are often simpler than in group plans, while the deductibles (the amount you have to pay before insurance benefits begin) and cost-sharing (the fees you pay directly to medical providers at the time of service) are typically higher than those in a group plan.
How are premium rates determined?
In New Hampshire, when you apply for individual health insurance coverage, you are asked to provide health information about yourself and any family members to be covered. When determining rates, insurance companies use the medical information on these applications, as well as information on the applicant's age and where they reside (determined by postal zip code.) Sometimes the insurance companies will request additional information from an applicant's physician or ask the applicants for clarification. As a rule, individual health insurance companies are much more limited than group insurance companies in their ability to spread risk. In New Hampshire, a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them "uninsurable." If the insurance company is unable to obtain information necessary to accurately determine the risk of a particular applicant, it will underwrite more conservatively (i.e. the assumption relative to the missing information will be negative rather than positive.)
Are health insurance companies required to issue individual policies to anyone who applies in New Hampshire?
No. Unlike in the neighboring states like Maine and Massachusetts, where health insurance is a "guaranteed issue" item, in New Hampshire individual health insurance is "fully underwritten." What this means is an insurance company that issues individual coverage underwrites the applications prior to the policy being issued. Underwriting is based on many things including (but not limited to) age, health status, occupation, and certain hobbies. Consequently, in New Hampshire a company may (1) issue the policy as you applied for it; (2) issue the policy with stipulated exclusions either for a limited or unlimited period of time; (3) issue the policy with an added premium; or (4) decline to issue you the policy.
NOTE: By law, if a policy is issued other than as you applied for it, the company must provide you with their reason for offering exclusions or a declination, upon your request.
If I am declined for an individual health insurance policy and do not have access to a group plan (i.e. I am self-employed, unemployed or retired), how do I get health insurance coverage for myself and/or my family?
If you've been declined for health insurance, the first thing you should do is find out why, and make sure that you were not declined in error. If you determine that you were legally declined coverage, and you are not eligible for Medicare or Medicaid, you have a couple of options:
1. Open Enrollment Period for "Groups of One." New Hampshire law (RSA 420-G:8 I-a.) allows health insurance plans to enroll individuals into certain plans as a "group of one," on a "guaranteed issue" basis, during the months of March and September each year.
2. The New Hampshire Health Plan (NHHP). NHHP is a state high risk pool established to provide health insurance to NH residents who a.) Are declined coverage through the private market, b.) Have a pre-qualifying condition or c.) Are otherwise eligible. The NHHP is intended generally to be the insurer of last resort for New Hampshire residents. Applicants are encouraged to seek coverage from private insurance companies before contacting the NHHP. NHHP also provides health insurance for individuals who are entitled for certain Trade Adjustment Act (TAA) or Pension Benefit Guaranty Corporation (PBGC) benefits. For these individuals, premiums may be payable through the federal health care tax credit program. To determine if you are eligible for the NHHP, go to www.nhhealthplan.org for more information.
3. New Hampshire Healthy Kids (NHHK). New Hampshire Healthy Kids Corporation (NHHK) was first established by special legislative act in 1993. Today NHHK provides access to free and low-cost health coverage to uninsured New Hampshire children of families who meet its income guidelines. (The NHHK also provides families at higher income levels with the opportunity to buy in to the program.) NHHK maintains contracts with Anthem BC/BS and Northeast Delta Dental to provide medical and dental insurance to children who qualify for the Title XXI program. These contracts encompass financial discounts negotiated by NHHK with the State's hospitals and hundreds of health care providers in order to keep the cost of coverage low. To determine if your children are eligible for the NHHK, go to www.nhhealthykids.com for more information.
Can I return my policy if I am not satisfied with it?
When a policy is issued to you, by law you have a "free look" period of no less than ten (10) days to review the policy and confirm that it meets your needs. If you are not satisfied with the policy, you may return it within the 10-day "free look" period and request a full refund of the premium (if any) paid when the application was submitted. To avoid any delay or confusion, if you decide you do not want the policy, you should return the policy directly to the company by certified mail within the "free look" period.
What is a "deductible" and how does it work?
A deductible is the amount of covered expenses you must pay before the insurance company will pay for any of the covered medical expenses. Be sure you understand exactly how the deductible works before buying any policy. There are a number of ways deductibles may be administered by the company: