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Guaranteed Issue

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Updated March 18, 2010

Definition:

If you are buying your own individual plan:

Guaranteed issue is a requirement by your state government that a health plan must allow you to enroll regardless of your health, age, gender, or other factors that might predict your use of health services (such as a pre-existing condition).

You can learn about your state’s requirements from the website State Health Facts.

If you are buying health insurance for a small company:

Federal law (and all the states) requires that all health plans sold to companies with 2 to 50 employees be on a guaranteed issue basis. This means that small employers cannot be turned down by a health based on the health status of its employees.

If you are self-employed and have no employees, the federal law does not require that health plans sell you a health plan on guaranteed issue basis. However, some states do have more extensive guaranteed issue requirements. For example, some states define a small employer as having 1 to 50 employees, thus requiring health insurers to include sole proprietors in guaranteed issue plans.

The State Health Facts website outlines the requirements for each state: Small Group Health Insurance Market Guaranteed Issue

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