Sunday, September 9, 2007

Health Insurance for Overweight Applicants

By Web Designs, MBA, MT, OnlineAdviserTM at

One in 50 adult Americans is clinically obese, according to a new Rand study. A clinically obese person is one who is more than 100 pounds overweight. These large people require extraordinary medical care that few medical facilities are equipped to handle. Most medical offices do not have scales to weigh patients over 300 pounds despite the fact that accurate weight is crucial to prescribing many types of medicines. These patients may not fit on normal hospital beds, imaging equipment, wheelchairs or operating tables. Severely overweight people are far more likely to suffer from diabetes, arthritis and other medical conditions.

The nation is slowly changing its attitude toward obesity as a medical condition. The IRS now allows the cost of weight loss programs to be deducted by taxpayers as a normal medical expense. Employee benefit plans may now classify weight control costs as a tax-free benefit under a health plan. The state of new Louisiana launched a study to examine the financial effects of gastric by-pass surgery on the overall health care costs of obese patients. If the results of this study are favorable, we might expect to see gastric bypass treatment routinely covered procedure under health insurance plans that are defined to cover "ordinary and necessary medical expenses".

For years health insurance companies have charged extra premiums to overweight members. In those cases where severe obesity is accompanied by full or partial disability, unemployment or underemployment, the high cost of these health insurance plans is unaffordable. Some health plans are simply not available to applicants who weigh more than allowed by the underwriters.

In small business health insurance plans, insurance is always available to every full-time employee regardless of weight or medical history. The extra cost of caring for overweight members is spread evenly among all of the employees of the business. Adding an obese employee can boost the premium cost by 5% to 25% for everyone in the group and may cause resentment among the lighter weight employees. Even in larger groups and Blue Cross plans that use a "one price for all" the high cost of treating obesity has become a politically charged issues.

There are still a few low cost health insurance plans available without regard to the applicant's weight.

The best option, when available, is Secure 3x12 STM, a comprehensive indemnity-type major medical plan with a good consumer reputation that will be issued at standard rates and does not screen for weight. It provides continuous coverage for 36 months and re-application is allowed for another 3 years, etc. Obese applicants are approved at standard rates without any extra charge.

Higher deductible policies are available to keep premiums affordable. The only downside is that pre-existing conditions are not picked up from one policy to the next. At this time, this insurance is available only in Alabama, Arizona, Delaware, D.C., Florida, Georgia, Hawaii, Illinois, Missouri, Nebraska, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Virginia, Wisconsin, and Wyoming. A shorter version of the policy is available in other states. More information can be found at .

In most states the American Health Shield or Simple STM policies (both available at offers full protection and can be issued at standard rates without regard to weight. Coverage always issued at standard rates because the application does not ask about the applicant's weight. This coverage plan is unavailable to individuals with diabetes (that often accompanies obesity) and to those who have previously been declined for coverage. The primary limitation is that this plan requires re-enrollment every six months and pre-existing medical conditions are not covered.

ValueMed Insurance - This insurance is available in all states except CT, KS, MN, NC, ND, NJ, NY, RI, VT and WA to applicants under age 65 without regard to weight. The coverage provided is generally focused on outpatient services but the medical eligibility is more liberal. This insurance pays expenses for pre-existing medical conditions after the policy has been in force for 12 months. This is a limited benefit insurance policy that pays a specific dollar amount that is less than the amount charged by a medical provider. The policy is renewable until age 65. Maximum benefits, premium rates and enrollment form are included in the enrollment kit. This insurance is available and paid in addition to any other insurance that may be available.

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