Utahns with individual health-insurance plans are at risk for higher premiums based on their health status, which is a weakness in the state's health-care policy, according to a report Thursday by a consumer advocacy group.
In Utah, if people are turned down for health insurance, they will usually seek insurance from a high-risk pool. While some states limit the cost of high-risk premiums to 125 percent of standard market rates, Utah has no such law. As a result, health-care premiums can spiral out of control and may not even provide effective coverage, according to the report by Families USA, a nonprofit, non-partisan group that promotes policies that foster affordable health care.
"It leaves consumers vulnerable," said Ella Hushagen, a policy analyst for Families USA, based in Washington, D.C.
The report looked at state regulations over the health-insurance market for people who seek individual policies, rather than group insurance. Families USA contacted insurance commissions in all 50 states.
Although more Americans are insured through employee group plans, 27 million people had individual insurance policies in 2006, and the number could grow as more people work part time, become independent contractors or have their health benefits dropped by employers due to rising costs, said Ron Pollack, Families USA executive director.
Individual insurance policies are like the "wild, wild West" of insurance because there is so little regulation, said Pollack, who would like to see federal standards in place to offer more protection to health-care consumers.
"There'd be a floor that nobody would fall under," he said.
Utah, like 48 other states, can revoke claims without state oversight. Utahns also lack a process through which they can appeal insurance-company decisions.
Families USA praised health-care regulations in Utah that prohibit insurance companies from denying coverage for a pre-existing condition for more than a year. And insurers, when deciding whether to accept an insurance application, are not allowed to look back more than six months at a patient's medical history."It's a good protection to have in place," Hushagen said. "Not a lot of states use the six-months standard."