Answer a personal health quiz or face raised rates

[Curious9]

What is the name of your state (only U.S. law)? Connecticut

Its time for my wife's insurance renewal. This year the plans are changing.. big time.

One of the changes is a 60% rate increase unless you answer their Health Quiz.

So, as I always look to save some money, I figure its some quiz about healthy living or something. And then I take the quiz.

This "Quiz" is nothing more than an attempt to gain personal medical history. Some of the questions asked:

Have you been diagnosed with the following:
Cancer
Menopause
Heat attack
(etc)

If you answer yes, they want to know the approximate date of this diagnosis. They want to know if is being treated or not.

They ask questions like Height, weight, waist size and if you've had a colonoscopy or pap smear in the past year, 2 years, 3-5, over 5 or never.

There's even questions asking if you do breast self exams, smoke, do drugs, drink, drive drunk or have taken a ride with a drunk driver in the past 6 months.

I'll be honest, I had to stop this quiz after the third page. I don't even know how much more detailed it gets.

I personally think that an insurance company has legal access to records if they need them.. And if they don't have this access there's a reason for it.

It seems to me that someone, whether the employer or the insurance company is trying to build a database of employee medical records/data and using this fee increase as leverage to make you take this quiz.

What I want to know:

Is it legal to force employees to take this invasive quiz (which most likely will be used to categorize, possibly deny coverage or raise future rates based on your "profile") or face a 60% premium increase? If you take the quiz, rates remain the same.

[ecmst12]

Group plans are not allowed to individually underwrite members. But they can assess the risk level of the group as a whole. Nothing illegal about that. They are also, it sounds like, trying to raise awareness about things you should be doing to keep yourself healthy and lower your risk.

[momm2500]

Wellness is a big thing insurance companies are promoting now a days. If we did not do the wellness assesment (or we could have our doctor fill out the paperwork after a visit) our rates would go up. If we did the assessment we got a 10% discount off of our premium

[CraigFL]

This tactic is interesting because yesterday on the Clark Howard Show he talked about companies getting around the HIPPA laws legally. The example he gave was that copay prescription drug providers-- the mail order ones that give you 90 day supply for the price of a 60 day supply-- are selling the personal drug buying information to insurance companies so that they can indirectly find out your medical history. This could lead to increased premiums or rejection from some insurers.

[cbg]

It would not be legal for your wife's employer to refuse her coverage because she did not complete the quiz.

It WOULD be legal for the insurance carrier to refuse to sell her employer a policy for the group (or to raise their rates significantly) because they were not given the medical information about the employees.

[Curious9]

Thanks for all the responses!

I spoke today with the person who handles the insurance policies for my employer (a different organization) and was told that some of the questions asked were a bit much. Also, we are located in CT and there is no pre-existing clauses which means they can not deny insurance for a pre-existing condition.

I do want to clarify one thing to avoid confusion - it's not the insurance company that is pushing this survey. In fact, it's the company themselves through a third-party website. Again, if the insurance company themselves really wanted to know when your last colonoscopy was, they could easily and legally find out by looking at their claim records.

In doing some more research, it seems this "quiz" is a health risk assessment and while packaged as a nice little survey to inform you about your health situation and track your medical records, the other side is that your employer and the third-party website now have a database of your medical records in the form of your answers to this survey.

As CraigFL said, once armed with your history, the next step is to raise rates. Or get around the illegality of denying insurance by raising the rates to unattainable levels.

After the changes between this year and last year's policies, I could easily see rate hikes in the future for the high risk pool.

Needless to say, I'm putting my wife on my plan.

What makes this so upsetting isn't a "We recommend this or encourage this." Its the "We're raising your rates unless you do this."

Edit:
I found some interesting articles about this:

[url]http://www.fiercehealthit.com/story/promoting-phr-use-is-it-a-good-idea/2007-04-23[/url]

and
[url]http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070416/FREE/70416001/1029/FREE[/url]

[cbg]

While it may not be legal to deny coverage because of a pre-existing condition, it IS legal to deny coverage because of a refusal to provide medical information.

Rates are based on an assessment of potential claims, which cannot be assessed without that information.

[lkc15507]

I agree with all the above, especially cbg, who has nailed the answer. However, this is one of those areas that makes me want to get on my soapbox again. It is all perfectly legal, yet it tap dances around the barely legal. No one is forced to answer these questions. But, as cbg points out, if an individual refuses, the entire group can be refused and / or have high / higher premiums. It is quite easy for the non-compliant one to suddenly go by the wayside. As a professional with the luxury of always being able to find a job, I never answer these questions. An employer and insurer must be quite careful in these situations because one losing one's job due to their health history is a monstrous no-no. But it is easy to get around. I absolutely hate it, but because I always try to give the practical answer, the answer here is to answer the questions or be prepared to look elsewhere for employment if you make too many waves.

Personally, I think the insurer can and should base risk assessment of a group upon the general demographics of the group. However, this practice is basing the group risk upon collective individual risk. And, I agree with the poster that it is an intrusive and invasive practice that should not be allowed. That's why I don't answer these questionnaires. lkc5507