Currently in Michigan, the number of uninsured adults (age 19-64) has reached 907,730 approximately 15% of the population. The costs of health insurance premiums have also risen by 66.4% which shows how essential it is to find the most affordable plan that best fits your lifestyle and needs. Coverage for individual health insurance in Michigan is provided through assorted plans depending on medical needs of the applicants. There is medical underwriting allowed in Michigan with exceptions for HMOs and Blue Cross Blue Shield of Michigan. Medical underwriting is the process a health insurance company goes through to assess the health status of individuals and use such information to determine if the insurance company wants to accept and application. Health insurance companies can look review your medical history for the last 6 months prior to coverage and coverage can be excluded for up to 12 months. For HMOs and BCBS of Michigan, pre-existing health conditions are covered and there is a 6 month limit on look back and exclusionary periods.
The state of Michigan does not offer a high risk pool; therefore, BCBS of Michigan must offer health care coverage to all medically uninsurable individuals. HMO’s must offer guarantee issue coverage to all resident individuals during annual open enrollment periods. Those who receive health insurance through Blue Cross Blue Shield of Michigan cannot be eligible for COBRA, or government programs and they must be a resident of Michigan. The rates under BCBS of Michigan are not restricted and depend solely on the plan. (www.coverageforall.org)
In Michigan, medical underwriting is allowed for group and small business health insurance. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior healthcare. HMO and BCBS of Michigan may have no exclusionary period. If uninsured for a previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply and benefits will vary depending on the chosen plan.
In Michigan, there are some factors that determine eligibility for group and small business health insurance. They include:
- Company size 2-50 employees
- Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage
- Owner can count as an employee
- Owner name on business license must draw wages from the company
The average monthly premium for group and small business health insurance in Michigan in 2006 was $315 for single coverage, but can depend on employer contribution and $826 for family coverage according to AHIP, The Center for Policy and Research.
Michigan offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. COBRA coverage is only available to someone who leaves a group of 20 or more employees. Groups with fewer than 20 employees, churches, and federal government plans are exempt from COBRA. You must apply through your group for COBRA continuation within 60 days of loss of coverage. To be eligible for COBRA coverage, your previous health insurance coverage must have been terminated for the following reasons:
- Layoff or reduction of hours
- Termination of employment which can be voluntary or involuntary
- Divorce or legal separation from a covered employee
- Death of a subscriber
- Loss of dependent eligibility status
- Marriage of a dependent child
Michigan Department of Insurance
Michigan Department of Health Services
Michigan Consumer Health Guide
