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Guarantee Issue of Individual Insurance Insurers in the individual
market must guarantee issue health coverage to "eligible individuals" without any pre-existing exclusion. In general, the types of plans offered in accordance with this law will be determined or guides by the
individual states. An eligible individual is defined as one who:
- has 18 months or more of creditable service under a health insurance plan and,
- most recently had coverage under a group, church or government plan and coverage did not terminate due to nonpayment of premium or fraud: and,
- is not eligible for coverage under a group plan, Medicare or Medicaid; and,
- has exhausted benefits (if applicable) under COBRA or State continuation.
States may adopt their own mechanisms to guarantee the availability of coverage to eligible individuals. If a state chooses not to adopt its own mechanism or if the Secy. of Health and Human
Services determines a state mechanism is inadequate under this law, insurers in the individual market in that state may make available either:
- Their two most popular individual plans; or,
- two plans offering the higher and lower benefits that are actively marketed and sold to individuals.
These options will be defined by regulation Guaranteed Renewal of Individual Insurance An insurer must renew individual policies except for:
- non payment of premiums or premiums not made on time
- fraud
- termination of coverage in the individual market
- movement outside the area (network plans)
- association plans, if a persons membership in the association ceases so long as coverage is not terminated due to health status or claim experience.
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