Group Health Insurance companies can not require you to pass a physical examination for enrollment. Even as a late enrollee, you may not be required to pass a physical examination in order to be eligible for group health insurance coverage.

The Health Insurance Portability and Accountability Act (HIPAA) provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage.

The HIPAA nondiscrimination provisions do not automatically prohibit health care questionnaires. It depends on how the information that is obtained is used. In this case, the plan requires individuals to score a certain number of Health Points that are related to prior or current medical conditions in order to enroll in the group health insurance plan, which is impermissible discrimination in rules for eligibility based on a health factor.

You can lower costs on individual health insurance plans by:

  • Reducing your coverage (the insurance company will apply the savings with a premium credit).
  • Put money into a HSA (health savings account) as part of a federally approved high-deductible major medical health insurance program (HDHP). A HDHP meets the requirements of the IRS, and in conjunction with an HSA allows you to pay medical expenses with pre-taxed dollars.
  • When your insurance company will not lowering your premiums opt for a higher deductible, if you’re in exceptionally good health.
  • Save money on your health insurance by eliminating unneeded coverage. For instance, if your individual health policy currently covers you for maternity, and you’re sure that you’re not going to need it, drop that coverage and save.

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