SelectHealth Private Health Plan Qualifications

6 days ago

3 min read

Private plans are great options for healthy families that make too much to still save money on their premiums.

If you are paying close to full price for your Marketplace health plan, private health insurance may be a great option to help you save on your monthly premium and still get coverage for major medical expenses. They differ quite a bit from your marketplace and group health plans in that there are certain services they don't cover like prescriptions or preventative care, but the lower premiums you can get, save you in the long run.

Do I qualify?

Private health plans do have some health questions to answer to qualify and get approved. After the application, the health insurance company will run a prescription check before you get approved. Here are the qualifying questions. If you can say no to all of them, then you may qualify.

Does any listed proposed insured live, reside, work or attend school outside the state of Utah at any time during the year?
Is any employer reimbursing or paying for any portion of this policy?
Is the applicant purchasing this plan using a reimbursement arrangement such as ICHRA, QSEHRA or HRA?
Will you, or any dependent to be covered, have any other health insurance coverage while this plan is in effect?
Are you, or any dependent to be covered, currently eligible for Medicare, or will you or any dependent become eligible for Medicare during the term of coverage you are selecting?
Currently pregnant or have reason to suspect you might be pregnant?
Financially responsible for an unborn child or anticipating, applying for, or have applied for adoption?
Male and weigh more than 300 pounds or female and weigh more than 250 pounds?
Have you, or any dependent to be covered, ever been declined for health insurance due to health reasons?
In the past 12 months, have you, or any dependent to be covered, been recommended to have, or been scheduled for, diagnostic testing, treatment, or surgery that has not been completed?
Within the past two years, have you, or any dependent to be covered, had a problem for which medical advice hasn't been sought?
Within the past five years, have you, or any other dependent to be covered, received any abnormal test results, medical or surgical treatment, healthcare professional consultation, or prescribed medication for any of these conditions?

AIDS or tested positive for HIV

Alcoholism, chemical dependency, drug or alcohol abuse

Cancer or tumor

Crohn's disease, ulcerative colitis, or hepatitis

Diabetes

Emphysema

Heart disorder, including any heart-related symptoms

Kidney disorder

Stroke

Prior Coverage

Are you, or any dependent to be covered, currently covered under any Select Health plan?
Have any applicants previously been covered under a Select Health Short-Term Limited Duration plan?

What is a pre-existing condition?

Private health plans do NOT cover any pre-existing condition. This means that if you've seen a doctor, taken a medication, had a follow up visit, had any blood work done for a certain condition, that condition and anything related to that condition will not be covered. Normally they look back 5 years, but depending on the plan it may be longer. For example, if you were diagnosed with hyperthyroidism 15 years ago and now take a daily medication for that condition and see your doctor once a year for a blood test, anything related to your thyroid condition would NOT be covered. Even though your diagnosis was 15 years ago, you were still seeing a doctor every year and taking a daily medication for that condition.

What services are not covered on private health plans?

Private health plans do NOT cover pregnancy, pre-existing conditions, prescriptions, preventative care and mental health therapy. These services you will need to pay out of your own pocket for and they will not go towards your deductible. The only exception is preventative care. Some preventative care visits and tests can go towards your deductible, but you will still need to pay for those services.