Are there government sponsored programs?Yes. Health coverage is available through the workers' compensation systems in the states if the care relates to injuries suffered on the job. Government subsidized or government provided care, includes Medicare for the elderly or disabled, or Medicaid (it may be known in different states by different names, such as MediCal in California) for the disadvantaged, CHAMPUS for military dependents, and Medically Indigent Adult (MIA) programs for the indigent poor at the county level. In addition to the foregoing, in many communities there are private free clinics unaffiliated with any insurance company, plan or government entity.d 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or human immunosuppressive virus (HIV) or mental illness.Health care insurance policies or plans can be canceled (rescinded) if there is a material omissions or misrepresentations made by the insured or member in the application for coverage.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.What is a health insurance policy?A health insurance policy is a binding contract issued by an insurance company to an individual or group which promises to pay for health care reasonably required by the "insured" or "policy holder" or "certificate holder" to treat illness or injury. If the insurance policy is issued to an individual, the individual applies for the policy and pays the premiums either directly or through payroll deduction. Typically, in individual health insurance the individual policyholder is insured and also, in exchange for a higher premium, the insurance covers a spouse and dependent family members.In the circumstance where the health insurance is obtained by an employer or a group or an association, the entity is the "group policyholder" and the covered individuals receive "certificates" of insurance. Generally, in addition to payment of premiums by the policyholder, the insured is also responsible for payment of deductibles and co-pays (a percentage of actual charges or a fixed amount per visit) which are predetermined in the policy at set amounts or rates.Can the insurer or plan cancel or rescind at any time?Generally state law and the policy itself provide that the insurer has only 2 years from the date of application to rescind. If discovery of the omission or misrepresentation occurs after the passage of the 2 year period of "contestability" the insurer is generally out of luck and can not cancel the policy. After that, an insurer may only be able to contest a claim on the basis of actual, intentional fraud on the part of the policyholder, and even that may be severely limited.Because some insurers engaged in "post-claim underwriting", a practice in which the insurer would write a policy and take the premium, and only after a claim was submitted look to "find a way out of it", many states have statutes which prohibit "post claims underwriting." In those states an insurer or plan cannot rescind or cancel a policy once an insured has filed a claim for benefits unless the insurer or plan can prove intentional fraud.
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