Private: Individual Health Insurance

How is individual insurance different from group insurance?

Individual health insurance is coverage that an individual purchases for himself and/or his family. Individual insurance policies and provisions are regulated by the state where the policy is purchased. Individual policies are often purchased with the advice of a professional insurance agent due to the complexity of coverage offerings.


Coverage in individual policies may be limited due to pre-existing conditions with certain kinds of medical care excluded as a result. This means that applicants for individual insurance will need to complete a brief medical questionnaire when applying for benefits and, unlike a group insurance policy, in most states a company can decide not to cover people with very serious medical conditions (e.g., HIV or cancer), deeming them “uninsurable.” However, under PPACA, as of March 23, 2010, health plans can no longer exclude, limit or deny coverage to a child under age 19 solely on the basis of a pre-existing condition. Beginning in 2014, insurers providing individual insurance will no longer be able to, in most cases, exclude, limit or deny coverage for any American solely on the basis of a pre-existing condition. There may be some situations where a plan has maintained special “grandfathered” status where this limitation would not apply.


Once the company has determined your health status, you will be assigned a rate class by the company and put into a pool of other insured individuals with similar health status. Your premium will be the rate charged to that entire class of customers. Subsequent annual renewal premium rates will be determined not by your individual claims, but instead by the claims experience of the entire rating class pool.


Because PTIB (Personal Touch Insurance. & Benefits) is an independent agency, representing mulitple companies, we can complete the comparisons to find the best rate and policy for your specific needs. Contact us for a no pressure comparison.