Who can I cover under my health insurance policy?

You may cover yourself, your legal spouse or domestic partner if your plan allows, your unmarried natural and adopted children, children for which you have guardianship, and step children for whom you supply financial support.

My child is in college, may I still cover him/her?

Yes, you may cover a child until his or her nineteenth birthday or if he or she is a full time student, usually until the child reaches the age of 26.

What is the difference between group and individual coverage?

Group insurance is usually offered through an employer.  A group plan cannot exclude a person because of their health status as the whole group has a shared risk.  Individual coverage is your own personal coverage based on your health status and history.

I have a pre-existing health condition and have lost my group coverage; does a private policy have to cover me?

No, insurance companies that sell private policies have the right to deny anyone on the basis of their health profile.

I have bought a private health plan for my whole family and now that I am pregnant, I am told that my pregnancy is not covered, could that be possible?

Yes, pregnancy coverage must be included in the package when you buy an individual policy.  It is usually offered by the company but is one of the add-on features that you need to research before you buy.

I bought an individual policy for myself and failed to mention that I have had a history of sinus problems because that cleared up 10 months ago.  Now I am told that my policy has been cancelled because I went for treatment again, is that legal?

Yes, you have to fully disclose your medical history whether you think it is relevant or not.  Private plans can cancel your coverage if you misrepresented any facts.

How long can I remain uninsured and still maintain my portability with another group plan concerning pre-existing?

You need to make sure your coverage does not lapse by more than 63 days.

Is a co-pay the same as co-insurance?

Not usually. A co-pay is a set amount that you must pay for a service under your health plan.  The co-insurance is the amount that is left to pay after the insurance company has paid for the service and after the co-pay has been applied.

What is covered for my children under Medicaid or Peachcare?

Both programs have  very comprehensive medical coverage with well child care visits, doctor and hospital care, dental and vision care.

My children are enrolled in Medicaid, may I go to any doctor’s office for their care?

No, you must use a doctor or provider that is enrolled in Georgia Medicaid.  If you are enrolled in Georgia Medicaid under one of the managed care plans, you must let the primary care provider for your child coordinate all your medical visits.

Disclaimer