I currently am on worker's compensation. Can my employer make me pay for my own health insurance while I'm off?

The employer generally has no obligation to maintain health coverage at its expense, although you probably have a right to COBRA it. Also, check the firm's long term and short term disability policies. Depending on what state you work in, your rights may be also different under some states' workers comp laws.

Are there dangers in cancelling health insurance?

There can be potential serious adverse consequences associated with canceling health. If you cancel health insurance before replacement health insurance coverage is confirmed and already available, there may be a gap in your health insurance coverage.

First, there is no assurance that you will be able to obtain new health insurance. You might be denied coverage due to health conditions that developed prior to applying for the new insurance or plan, or go completely uncovered during the underwriting process. Second, even if you are accepted for subsequent health insurance coverage you could face a situation in which certain medical conditions that developed during the prior health insurance coverage are excluded from coverage under the new insurance as "preexisting conditions."

These problems may not exist if you are moving from one group insurance plan to another, as many group policies ignore pre-existing conditions if you move from a similar group health coverage within 30 days of prior coverage. A second exception will probably result in the same continuation of coverage mandated by HIPAA on and after January 1, 1998.

If I cancel do I get my unused premium back?

That may depend on the state involved and the policy you have. You generally do not get back any premiums that have been paid and applied to the period of time for which coverage was available.

Can I cancel my health insurance, and will there be a penalty or adverse consequence?

Generally, there is no prohibition against insured or plan members canceling their health insurance coverage or their participation in a health service plan.

One major exception to this generality is in the case of Medicare assignments. If a Medicare recipient has chosen to obtain private insurance or HMO coverage involving an assignment of the Medicare benefits to the insurer or plan, the Medicare recipient must apply to the Health Care Financing Administration (HCFA) before changing insurers or plans. Otherwise, there is no financial penalty per se to canceling health insurance coverage.

Can a health insurance company or health service plan cancel my policy for membership for any reason?

As a general proposition, insurers and plans cannot cancel an individual's coverage under a policy or plan arbitrarily. In addition, federal and state laws prohibit discrimination based upon race, national origin, gender or age. Some states have been proactive, as well, in the area of discrimination involving particular medical conditions or traits. For instance, some states prohibit insurers and plans from denying health care coverage to, or canceling health care coverage of, persons with mental dementia (such as Alzheimer's disease) or human immunosuppressive virus (HIV) or mental illness.

Health care insurance policies or plans can be canceled (rescinded) if there is a material omissions or misrepresentations made by the insured or member in the application for coverage. Recession, in general, works as follows: when you apply for insurance and sign an application, you answer questions and provide information about the medical history of anyone who will be covered under the policy or plan. In doing so, you must reveal any serious medical condition or treatment that might reasonably affect the decision by the insurer or plan to undertake the risk associated with providing the coverage.

Even if the policy or plan is issued and premiums are paid, the insurer or plan can cancel or rescind the policy later if they discover that the policyholder or insured did not disclose in the application significant medical history. The result is that the insurer or plan does not pay for the care that was rendered, the policy is canceled and the premiums that were paid on the policy are returned to the policyholder less a reasonable cost of insurance associated with the period of time during which the policy was in force.

A limited form of cancellation can occur involving reduction or elimination of benefits. Other than a requirement of reasonable notice, insurers and plans may reduce or eliminate benefits, unless the contract or plan prohibits it or limits it. In some states there is a major exception known as "vesting," which means that if the insured or member already has a claim or has received benefits for a particular injury or illness, they may continue to receive the benefit even if it is otherwise canceled.

General Health Insurance Questions

FAQs

How do I obtain health insurance?

Are there government sponsored programs?

Can a health insurance company or health service plan cancel my policy for membership for any reason?

What is a health insurance policy?

Can the insurer or plan cancel or rescind at any time?

What if the insured lied about a heart attack?

Can I cancel my health insurance, and will there be a penalty or adverse consequence?

If I think certain words in my policy mean something different from what my insurance company says they mean, how do we resolve it?

If I cancel do I get my unused premium back?

How does an insurance policy ‘protect’ me?

Are there dangers in cancelling health insurance?

What will happen to our health insurance for my dependent children and I after the divorce from their father?

What are typical problems that arise in getting health care benefits provided or paid?

My father who has conjestive heart failure and type 2 diabetes recently underwent a quintuple heart bypass. His medical bills are staggering and he has no health insurance. Short of filing bankruptcy, what are his options in getting these amounts reduced?

What can, or must, I do when a health insurance company or plan refuses to pay a claim or provide a benefit or service?

How long will my medical insurance allow my new baby and myself remain in the hospital following childbirth?

Are there any limitations on what an insurance company can charge for insurance?

What is the appeals and grievance process like?

What to Ask Insurance Salespeople When Buying a Medical Insurance Policy

What is a health insurance plan?

I currently am on worker's compensation. Can my employer make me pay for my own health insurance while I'm off?

How does a health insurance policy or health plan protect me?

What are my legal remedies if a health insurance company or plan refuses to pay a claim for a benefit or service?

How do I determine what my health care coverage or benefits are?

Would I need a lawyer to handle my case?

Suppose the contract or booklet is ambiguous or unclear?

What is health insurance?

What are ‘definitions,’ ‘benefits,’ ‘limitations,’ and ‘exclusions?’

What is private indemnity insurance?

Are there any government agencies that regulate how health insurance companies or plans operate?

What are health care maintenance organizations?

Will one of these many agencies be able to help me?

What about employer sponsored plans?

Compare our Core Plans for Individuals

£Sterling €Euro $US Dollars

Core Plans

Treatment Guarantee is required for all in-patient benefits () and may be required for other benefits () as indicated in the table below - please refer to note 2 for more information. These plans are valid from 1st November 2008. To change currency, please use the dropdown menu above.

		Premier Individual	Club Individual	Classic Individual	Essential Individual
	Maximum plan benefit	€2,250,000	€1,500,000	€1,125,000	€500,000
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()">	In-patient benefits - please refer to note 2 for Treatment Guarantee
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Hospital accommodation refers to standard private or semi-private accommodation as indicated on the Table of Benefits. Deluxe, executive rooms and suites are not covered.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Hospital accommodation	Private room	Private room	Private room	Semi-private room
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Prescription drugs refers to products, including insulin, hypodermic needles or syringes, prescribed by a medical practitioner for the treatment of a confirmed diagnosis or medical condition or to compensate vital bodily substances. The prescribed drugs must be clinically proven to be effective, and recognised by the pharmaceutical regulator in a given country.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Prescription drugs and materials	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()">	Surgical fees, including anaesthesia & theatre charges	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()">	Physician and therapist fees	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Surgical appliances and prostheses refers to artificial body parts or devices, which are an integral part of a surgical procedure or part of any medically necessary treatment following surgery.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Surgical appliances and prostheses	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()">	Diagnostic tests	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Organ transplant is the surgical procedure in performing the following organ and/or tissue transplants: heart, heart/valve, heart/lung, liver, pancreas, pancreas/kidney, kidney, bone marrow, parathyroid, muscular/skeletal and cornea transplants. Expenses incurred in the acquisition of organs are not reimbursable.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Organ transplant	Full refund	Full refund	Full refund	€10,000
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Psychiatry and psychotherapy refers to treatment of a mental, nervous or eating disorder carried out by a clinical psychiatrist or clinical psychologist. The disorder must be associated with present distress, or substantial impairment of the individual’s ability to function in a major life activity (e.g. employment). The aforementioned condition must be clinically significant and not merely an expected response to a particular event such as bereavement, relationship or academic problems and acculturation. The disorder must meet the criteria for classification under an international classification system such as the Diagnostic and Statistical Manual (DSM-IV) or the International Classification of Diseases (ICD-10).","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Psychiatry and psychotherapy (10 month waiting period applies)	Full refund	€6,000	€5,000	€5,000
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()"> Accommodation costs for one parent staying in hospital with an insured child under 18 refers to the hospital accommodation costs of one parent for the duration of the insured child’s admission to hospital for eligible treatment. If a suitable bed is not available in the hospital, we will contribute the equivalent of a 3 star daily room rate towards any hotel costs incurred. We will not, however, cover sundry expenses such as meals, telephone calls, newspapers etc.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Accommodation costs for one parent staying in hospital with an insured child under 18	Full refund	Full refund	Full refund	Full refund
Emergency in-patient dental treatment refers to acute emergency dental treatment due to a serious accident requiring hospitalisation. The treatment must be received within 24 hours of the emergency event. Please note that cover under this benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses, orthodontics or periodontics. If cover is provided for these benefits, it will be listed separately in the Table of Benefits.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Emergency in-patient dental treatment	Full refund	Full refund	Full refund	Full refund
‘1’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 80% of the eligible benefits.","", 300, "one")' ;="" onmouseout="hideddrivetip()">	Other benefits - please refer to note 2 for Treatment Guarantee
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Day-care treatment is treatment received in a hospital or day-care facility during the day, including a hospital room and nursing that does not medically require the patient to stay overnight and where a discharge note is issued.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Day-care treatment	Full refund	Full refund	Full refund	Full refund
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Out-patient surgery is a surgical procedure performed in a surgery, hospital, day-care facility or out-patient department that does not require the patient to stay overnight out of medical necessity.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Out-patient surgery	Full refund	Full refund	Full refund	Full refund
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Nursing at home or in a convalescent home refers to nursing received immediately after or instead of eligible in-patient or day-care treatment. We will only pay the benefit listed in the Table of Benefits where the treating doctor decides (and our Medical Director agrees) that it is medically necessary for the member to stay in a convalescent home or have a nurse in attendance at home. Cover is not provided for spas, cure centres and health resorts or in relation to palliative care or long term care (as defined).","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Nursing at home or in a convalescent home (immediately after or instead of hospitalisation)	€4,250	€2,830	€2,500	€2,500
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Rehabilitation is treatment aimed at the restoration of a normal form and/or function after an acute illness or injury. The rehabilitation benefit is payable only for treatment that starts immediately after the acute medical treatment ceases.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Rehabilitation treatment (immediately after acute medical treatment ceases)	€4,420	N/A	N/A	N/A
Local ambulance is ambulance transport, required for an emergency or out of medical necessity, to the nearest available and appropriate hospital or licensed medical facility.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Local ambulance	Full refund	Full refund	Full refund	€500
Emergency treatment outside area of cover. Where applicable, you and your dependants will be covered for emergencies only, which occur during business and holiday trips, outside of your chosen area of cover (where relevant). Cover is provided up to a maximum period of 6 weeks per trip within the maximum benefit amount. You will not be covered for any curative or follow-up non-emergency treatment, even if deemed unable to travel to a country within your geographical area of cover. Not only are you covered in the event of an accident but you are also covered for the sudden beginning or worsening of a severe illness, resulting in a medical condition that presents an immediate threat to your health. To be considered emergency treatment, and thus covered under this benefit, please remember that the medical treatment (through a physician, general practitioner or specialist) should commence within 24 hours of the emergency event.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Emergency treatment outside area of cover (for trips of a maximum period of 6 weeks)	Full Refund Max. 42 days	Full Refund Max. 42 days	Full Refund Max. 42 days	Up to €10,000 Max. 42 days
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Medical evacuation applies where the necessary treatment for which the insured person is covered is not available locally or if adequately screened blood is unavailable in the event of an emergency. We will evacuate the insured person to the nearest appropriate medical centre. Please note that the nearest appropriate medical centre may not be located in your home country. Following completion of treatment, we will also cover the cost of the return trip, at economy rates, for the evacuated member to return to his/her principle country of residence. If medical necessity prevents the insured member from undertaking the evacuation or transportation following discharge from an in-patient episode of care, we will cover the reasonable costs of hotel accommodation up to a maximum of 7 days, comprising of a private room with en suite facilities. Where an insured member has been evacuated to the nearest centre of excellence for ongoing treatment, we will agree to cover the reasonable cost of hotel accommodation comprising of a private room with en suite facilities.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Medical evacuation	Full refund	Full refund	Full refund	Full refund
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Expenses for one person accompanying an evacuated/repatriated person refers to the cost of one person travelling with the evacuated/repatriated person. If this cannot take place in the same transportation vehicle, transport at economy rates will be paid for. Following completion of treatment, we will also cover the cost of the return trip, at economy rates, for the accompanying person to return to the country from where the evacuation/repatriation originated. Cover does not extend to hotel accommodation and other related expenses.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Expenses for one person accompanying an evacuated or repatriated person	€3,000	€3,000	€3,000	€3,000
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Repatriation of mortal remains is the transportation of the insured person’s mortal remains from the principal country of residence to the country of burial. Covered expenses include, but are not limited to, expenses for embalming, a container legally appropriate for transportation, shipping costs and the necessary government authorisations. Cremation costs will only be covered in the event that this is required for legal purposes. Costs incurred by any accompanying persons are not covered.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Repatriation of mortal remains	€10,000	€10,000	€10,000	€10,000
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> CT, MRI and PET scans, as well as CT/PET scans, carried out on an in-patient or out-patient basis. Submission of a Treatment Guarantee Form is required for MRI, PET and CT/PET scans.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	CT, MRI & PET scans (in-patient and out-patient treatment)	Full refund	Full refund	Full refund	Full refund
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Oncology refers to specialist fees, diagnostic tests, radiotherapy, chemotherapy, and hospital charges incurred in relation to the planning and carrying out treatment for cancer, from the point of diagnosis.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Oncology (in-patient and out-patient treatment)	Full refund	Full refund	Full refund	Full refund
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Complications of pregnancy relates to the health of the mother. Only the following complications that arise during the pre-natal stages of pregnancy are covered: ectopic pregnancy, miscarriage, stillbirth and hydatidiform mole.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Complications of pregnancy (in-patient and out-patient treatment) (10 month waiting period applies)	Full refund	Full refund	Full refund	N/A
Laser eye treatment refers to the surgical improvement of the refractive quality of the cornea using laser technology, including necessary pre-operative investigations.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Laser eye treatment (limited to one treatment per lifetime)	€1,000 per lifetime	€500 per lifetime	N/A	N/A
In-patient cash benefit is payable when treatment and accommodation for a medical condition, that would otherwise be covered under the insured’s plan, is provided in a hospital where no charges are billed. Cover is limited to the amount specified in the Table of Benefits and is payable upon discharge from hospital.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	In-patient cash benefit (per night) (where treatment has been received free of charge)	€150 Max. 25 nights	€150 Max. 25 nights	€150 Max. 25 nights	€150 Max. 25 nights
Emergency out-patient treatment is treatment received in a casualty ward/emergency room following an accident or sudden illness, where the insured does not, out of medical necessity, occupy a hospital bed. The treatment must be received within 24 hours of the emergency event.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Emergency out-patient treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate out-patient plan)	€750	€750	€750	N/A
Emergency out-patient dental treatment is treatment received in a dental surgery/hospital emergency room for the immediate relief of dental pain, including temporary fillings limited to three fillings per Insurance Year, and/or the repair of damage caused in an accident. The treatment must be received within 24 hours of the emergency event. This does not include any form of dental prosthesis and root canal treatment.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	Emergency out-patient dental treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate dental plan)	€750	€500	N/A	N/A
‘2’, we reserve the right to decline a claim. If in the aftermath the respective treatment is proven medically necessary, we will pay only 50% of the eligible benefits.","", 300, "two")' ;="" onmouseout="hideddrivetip()"> Palliative care refers to in-patient, day-care or out-patient treatment following the diagnosis that your condition is terminal and treatment can no longer be expected to cure your condition. Included within your benefit we will pay for your physical care, pyschological care as well as hospital or hospice accommodation, nursing care and prescription drugs. Long term care refers to care over an extended period of time after the acute treatment has been completed, usually for a chronic condition or disability requiring periodic, intermittent or continuous care. Long term care can be provided at home, in the community, in a hospital or in a nursing home.","", 500, "def")' ;="" onmouseout="hideddrivetip()">	NEW Palliative care and long term care	Full refund, Max. 30 days per lifetime	Full refund, Max. 30 days per lifetime	Full refund, Max. 30 days per lifetime	Full refund, Max. 30 days per lifetime