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Finding Individual Health Insurance

Many words describe diabetes, but one that's on top of anybody's list is "expensive." Fortunately, most people is the United States are under some sort of group health insurance program--either through their place of employment or an organization of which they're a member.

The plan may be the traditional fee-for-service where the insurance company pays the full cost. Or, more often, it's a policy that covers some of the medical costs, as they occur, with the insured party picking up the rest of the cost--with or without an initial deductible.

There are also plans with a prepaid yearly fee that covers comprehensive health care. However, the care must be obtained only from certain physicians and hospitals. The best known of these are the Health Maintenance Organizations (HMOs).

Some people, however, are not covered through any type of group insurance. They may be unemployed, self-empllyed, or work for a small business that does not have enough employees to qualify for grou insurance. Such people must buy individual health insurance.

Individual health insurance is not cheap, and it's never been easy. According to the Health Insurance Association of America (HIAA), it is becoming even more difficult to obtain individual health policies.

In addition, a major difficulty with these policies is that they call for substantially higher premiums than do policies obtained through a group. They also generally have longer periods of time whenthey exclude either diabetes in general or certain aspects of diabetes as a preexisting condition.

Other Routes

Nevertheless, if you are not eligible for any type of group insurance, take heart. There are routes you can pursue to obtain individual insurance.

* In many states, Blue Cross/Blue Shield has "open enrollment" periods when they offer policies to individuals living in that state, regardless of the person's health status. The following states have such mandated open enrollment periods:

District of Columbia Maryland Massachusetts Michigan New Hampshire New Jersey New York North Carolina Pennsylvania Rhode Island Vermont Virginia

Although your state may not have mandated open enrollment periods, certain insurance companies and health maintenance organizations (HMOs) within your state may offer open enrollment times on their own.

Please note, though, that frequently the coverage offered under open enrollment is not as complete as coverage offered under group policies.

* For more information about particular health insurance opportunities in your state, contact your State Insurance Commissioner's Office. The Commisioner's office may also be useful if you are having difficulties with your current insurance company. Look under states government in the telephone book.

* In a growing number of states, highrisk people (this term generally includes those with insulin-dependent diabetes) now have access to health insurance risk pools. However, risk pools do not eliminate all barriers to obtaining individual health insurance, because the insurance available through them is usually expensive.

State that have mandated risk pools include:

California (*) Colorado (*) Connecticut Florida Georgia (*) Illinois Indiana Iowa Louisiana (*) Maine Minnesota Missouri (*) Montana Nebraska New Mexico North Dakota Oregon South Carolina Tennessee Texas (*) Utah (*) Washington Wisconsin Wyoming (*)

(*) Law recently passed and may not be in operation.

For more information about risk pools in your state, contact your State Insurance Commissioner's Office.

*A small number of states have recently begun state-supported, state-subsidized health insurance plans for children. However, you may find these plans only available based on your family's income. If you are interested, your State Insurance commissioner's Office can tell you whether such innovative plans are avialable in your state.

* The Health Insurance Association of America, the American Council of Life Insurance, and the Insurance Information Institute run a helpline that provides general information on life, health, and property / casualty insurance. The Holpline number is 1-800-942-4242.

ADA Goals

THe National Center of the American Diabetes Association is well aware of the difficulties peole with diabetes have in finding health insurance companies that provide coverage on an individual basis.

The Association is conducting a long-term project to identify such companies. Through this project, the Assocation has developed a list of seven companies. However, compiling the list has been very difficult, partly because conditions in the insurance industry change rapidly.

Although the following companies are now on our list, even they may place limitations on their coverage for people with diabetes and/or charge them higher premiums. However, they have told ADA they do offer policies on an individual basis to people with diabetes.

For information, contact the company home office at the number listed below--particularly if uou want to find out whether the company offers coverage in your state, and to obtain phone numbers and addresses of regional offices.

* Globe Life and Accident 800-654-5433

* Union Bankers 214-939-0821

* Bankers Life and Casualty 312-777-7000

* Ira Unger Agency representing United American 404-871-3639

*Physicians Mutual Ins. Co. (hospital supplements only) 800-228-9100

* Diabetes Group Insurance Trust Plans 800-527-0965 (In Kansas, call collect 913-268-7878 (per day for hospital stays only)

*Mutual of Omaha 504-291-7575 (Ask for David Gregory) (in-hospital plan only for Louisiana, Oklahoma, and Texas)

*George Washington University Health Plan 202-416-0444 (in Washington, D.C. Metropolitan are only. Considers coverage on a case-by-case basis.)

NOTE: N either Forecast nor the American Diabetes Association can take responsibility for the quality of the services provided by the insurance companies in this list or the policies they offer.

Also, it is important to undestand that this list does not constitute an endorsement or recommendation of a particualr insurance company by the American Diabetes Association, nor does it imply a complete listing of health insurance companies.

To help with our project, the ADA would appreciate your written comments about any experiences you have had, or know about, with any insurance companies including, but not limited to the companies mentioned above. Send these comments to: ADA Insurance Project, 1660 Duke Street, Alexandria, VA 22314 (1-800-232-3472).