Friday, January 31, 2014

What types of health information are consumers compelled to divulge under Affordable Care Act rules?

I just selected a new health insurance plan and they’re asking me questions about my health. I thought insurance companies can’t do this anymore?

Under health care reform laws, insurance companies can’t require you to answer health questions in order to buy insurance.

However, once you are covered by a health plan, companies are allowed to ask questions to determine whether you qualify for one of their disease management programs or for case management services. Disease management programs help consumers learn how to manage chronic health conditions such as diabetes, heart disease, or depression.

Case management programs help consumers who have very serious health conditions, such as leukemia, cut through the red tape to get the insurance company to pay for their treatment. For example, to prevent misdiagnosis, some insurance companies won’t start paying for cancer treatment until consumers get a second opinion to confirm the diagnosis. The average consumer wouldn’t know this, but a case manager will tell the consumer about this requirement and, if necessary, help the consumer schedule an appointment for a second opinion. Many case managers are also licensed nurses, so they can also suggest solutions to problems, such as side effects, that consumers experience during treatment.

Both of these services are voluntary, so you don’t have to answer the questions. Even if you do answer the questions, you don’t have to participate in the programs.

I recently applied for life insurance and they made me answer questions about my health. I thought insurance companies can’t do this anymore?

Under health care reform laws, insurance companies can’t require you answer health questions in order to buy medical insurance. However, insurance companies can still require to you answer health questions to buy other types of insurance, including:

  • Life insurance 
  • Long-term care insurance 
  • Dental insurance
  • Vision insurance 
  • Disability insurance
  • Medicare Supplement plans and Medicare Advantage plans, under certain circumstances

Read more information about health care reform.

Our consumer experts can answer your questions about any type of insurance. They are available by phone at 1-800-562-6900 or by submitting an inquiry through our website.