Individual Health Insurance Policy

By: EconomyWatch Content   Date: 8 February 2010

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 An individual health insurance policy is designed especially for those who are not eligible for group or government plans. However, individuals who are already insured can also purchase them to extend their medical cover.

How to Choose an Individual Health Insurance Policy?

An individual health insurance policy is available as an indemnity plan or a managed care plan. While choosing between the two variants, one should consider the cost as well as the scope of coverage.

Check if your doctors participate in a managed care network in the region. If they are a part of any network, you can purchase the related HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), POS (Point-of-Service) or EPO (Exclusive Provider Organization). Suppose, they are not a member of any of the health insurance networks and you do not want to change the doctor; then HMO and EPO plans are ruled out as they do not cover out-of-network medical expenses. PPO or POS plans cover out-of-network medical expenses, but with certain limitations. However, indemnity plans offer full freedom in selecting the physical care provider.

Is It Possible to Change an Individual Health Insurance Plan?

In every nation, shifting from an individual health insurance plan to another is possible. However in the US, the governing terms and conditions depend on the plan with which the existing plan is replaced.

The conditions under which an individual can shift to a new plan anytime are:

  • Selecting a new plan with lower premium.

  • Shifting to a new plan with same or greater deductibles, coinsurance and co-payments.

The conditions where a policy shift is governed by certain restrictions are:

  • A HMO plan can be replaced with another HMO plan that requires lower co-payments or with a non-HMO during the open enrollment period.

  • If an individual has bought an HMO plan for the first time, it is possible to replace it in the first 90 days with a non-HMO plan.

  • A basic and essential plan can be changed to a standard individual insurance plan or to another basic and essential plan with a different rider.

  • A basic and essential plan with a rider can be converted to a basic and essential plan without a rider any time.

Except in the US, there are no strict regulations that govern individual health insurance plans for private carriers.


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