National Health Policy Forum

Background Paper

Date: APRIL 13, 2005
Title:
Fundamentals of Underwriting in the
Nongroup Health Insurance Market: Access
to Coverage and Options for Reform
PDF Doc.
Author: Mark Merlis, Consultant
Summary: Although the majority of Americans with health insurance obtain coverage through their employers, many individuals must negotiate the nongroup insurance market alone. Insurers use a process called medical underwriting to identify applicants with current or recent medical problems. Because these applicants are likely to cost the insurer more in claims than a healthier person, insurers may charge them higher premiums or restrict or deny coverage. This background paper reviews the practice of underwriting, state and federal regulation of insurers offering nongroup health coverage, and several proposed options for improving access to coverage for applicants who are in poor health.
Related
Materials:
See also "Underwriting, Rating, and Regulation in the Individual Market" (Small-Group Session, December 3, 2008).