Primer on Post-Claims Underwriting

The little-known practice of “post-claims underwriting” is when an insurer investigates an individual or small group policyholder’s medical history after the policy has been issued – and after claims have been submitted. Insurers have said that post-claims underwriting prevents fraud and therefore helps keep premiums low. But for individuals whose health coverage has been canceled after the onset of a serious medical condition, post-claims underwriting can have serious consequences for their health and financial well-being.

A primer developed by Peter Harbage and Hilary Haycock of Harbage Consulting – and funded by the Robert Wood Johnson Foundation – explores the practice, which is increasingly getting attention on Capitol Hill. The primer explores what is known and unknown about post-claims underwriting, and related state and federal regulations.