Saving You Money For Life

The Los Angeles Times has obtained sets of guidelines that the state’s four major health insurers provide to their insurance agents proscribing a set of occupations and medications that would preclude individuals getting coverage. The party seeking coverage would not be privy to the reason for rejection.

Blue Cross, Blue Shield, PacifiCare and HealthNet have private benchmarks for their insurance agents to take into account. All four health plans look at prescription drug use to decide to whom they will sell individual policies. Dozens of widely prescribed medications — including Allegra, Celebrex and Prevacid — may lead to rejection, according to the underwriting guidelines that the health plans provide to insurance brokers but not to the public.

PacifiCare and HealthNet include pyrotechnicians, crop dusters and stunt pilots on their lists of occupations that are ineligible for individual coverage. PacifiCare’s no-sell list also includes police officers and firefighters.

Senate President Pro Tem Don Perata has proposed a bill that would extend coverage by creating a purchasing pool that would require participating plans to offer coverage to people with preexisting conditions or who are priced out of the market. It is probably news to many in the state legislature, however, that widely advertised medications are considered a pre-existing condition that precludes medical coverage.

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