Underwriting Purposes

Date of Publication:

3/13/2019

Definition:

With respect to a health plan, includes: Rules for, or determination of, eligibility (including enrollment and continued eligibility) for, or determination of, benefits under the plan, coverage, or policy (including changes in deductibles or other cost-sharing mechanisms in return for activities such as completing a health risk assessment or participating in a wellness program). The computation of premium or contribution amounts under the plan, coverage, or policy (including discounts, rebates, payments in kind, or other premium differential mechanisms in return for activities such as completing a health risk assessment or participating in a wellness program). The application of any pre-existing condition exclusion under the plan, coverage, or policy. Other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits. Underwriting purposes does not include determinations of medical appropriateness where an individual seeks a benefit under the plan, coverage, or policy.