Health Insurance: What is Guaranteed Issue?

Receptionist taking patients insurance card in dentists office
Hero Images/Hero Images/Getty Images

In health insurance, guaranteed issue refers to a circumstance in which a health care policy is offered to any and all potentially eligible applicants regardless of health status. Guaranteed issue is often utilized to help individuals with long-standing, pre-existing medical issues gain health insurance where they may not otherwise be able to.

Guaranteed Issue If You are Buying an Individual Plan

Guaranteed issue is a requirement by your state government that a health plan must allow you to enroll regardless of your health, age, gender, or other factors that might predict your use of health services, such as a pre-existing condition.

A pre-existing condition is any sort of health problem or issue that existed prior to you applying for a health insurance policy. Millions of Americans have such pre-existing conditions.

Guaranteed Issue If You are Buying Health Insurance for a Small Company

Federal law (as well as all of the states) requires that all health care plans sold to companies with 2 to 50 employees be on a guaranteed issue basis. This means that small employers cannot be turned down based on the health status of its employees.

If you are self-employed and have no employees, the federal law does not require that health plans sell you a health plan on guaranteed issue basis.

However, some states do have more extensive guaranteed issue requirements. For example, some states define a small employer as having 1 to 50 employees, thus requiring health insurers to include sole proprietors in guaranteed issue plans.

Guaranteed Issue Under the Affordable Care Act (ACA)

Under the Affordable Care Act, which went into effect in 2010, all health insurance policies must be sold on a guaranteed issue basis.

Thus, all health care policies cannot exclude individuals based on pre-existing medical conditions.This is good news for those with pre-existing medical conditions.

The installation of the Affordable Care Act in 2010 has made getting health insurance in the United States a whole lot easier for people with pre-existing conditions.

However, a pre-existing condition can still cause some serious insurance issues in some unfortunate cases.

Guaranteed Issue Outside of the United States

While the Affordable Care Act has made getting health insurance in the United States a whole lot easier for people with pre-existing conditions, it has its limitations. The Affordable Care Act only impacts health insurance in the United States. Countries outside of the United States have different rules governing the selling of health insurance.

The sailing is not entirely smooth even in the United States for those with pre-existing conditions. There are still three particular instances where your pre-existing condition can still be an issue. Learn more about these three particular instances in “3 Ways Your Pre-Existing Condition Still Causes Insurance Problems.’

Continue Reading