Can a health insurance policy dictate where you live?

Question

My grandfather has a health insurance policy with Monumental and he is convinced that he is not allowed to move one county north or he will be dropped from his policy. I told him that, most likely, he will just need to find a new doctor and that, since Monumental is a national company, it probably won't be a major issue.

Is my grandfather crazy (my hunch) or can a health insurance policy prohibit you from moving?

Answer 1

No, a health insurance company cannot prohibit anyone from moving, but depending on what type of plan you have, you must reside in the coverage area to receive coverage from the plan. Even though it is a national company, it probably doesn't cover every single area in the country. First, you need to find out exactly what type of plan he has. Monumental Life Insurance Company offers Medicare Supplement plans. With Medicare Supplement plans, it shouldn't matter where he lives. However, I think Monumental also offers Medicare Select, which is a type of Medicare Supplement. If he is under one of those plans, it WOULD matter where he lives, as those types of plans only have coverage in select areas.

My best guess is that they might be trying to tell him that they don't cover the area he's moving to and that if he moves there, he won't be able to keep the plan because he'll be out of area. The only way to find out for sure is if he calls them and asks them exactly why they are saying his policy will be dropped if he moves there.

Answer 2

They can't keep him from moving.

However, its possible that the company doesn't do business in the area that your grandfather is thinking about moving to - if he's on a Medicare replacement plan, he may have to select another insurance carrier to go through.

BTW - I've never heard of Monumental, and I've worked with literally thousands of insurance companies nationally. (Did contracting for a large national provider group, and we had contracts with every major national and regional insurance carrier.)

When I tried searching for info, all I got was that there is a large US life insurance company called Monumental. But they aren't a health insurer, though according to their website they sell health discount cards.

Are you sure your grandfather's health insurance company is called Monumental? And, if so, is he in the United States?

Answer 3

If your grandfather is on a Medicare Supplement and it is not an HMO, coverage should extend from state to state (so county to county wouldn't be a problem). The changing of physicians should also just be a convenience factor for your grandfather - as long as the doctor is in network benefits should pay the same. When in doubt, have your grandfather call Monumental and ask.

Answer 4

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RE :Can a health insurance policy dictate where you live?
My grandfather has a health insurance policy with Monumental and he is convinced that he is not allowed to move one county north or he will be dropped from his policy. I told him that, most likely, he will just need to find a new doctor and that, since Monumental is a national company, it probably won't be a major issue.

Is my grandfather crazy (my hunch) or can a health insurance policy prohibit you from moving?
Follow 11 answers

Answer 5

They can't prohibit you from moving, per se, but a health insurance can dictate their coverage area, so his plan may only cover the area he lives in. I've never heard of Monumental insurance, so I don't know that it is a national company, it could be regional. I don't know any that are county-specific, but some of them have fewer providers in different areas. Take New York for example - there's a plan based in NYC called GHI. In the 5 boroughs, you have a zillion choices for providers. The further north you go, the fewer providers accept the plan. When you get around Albany, nobody's even heard of it. See what I'm saying? Best bet would be for him to call his plan and ask that if he moves to wherever, would his plan change or just his providers.

Answer 6

Well, they obviously can't prohibit you from moving. But if you do choose to move, you may not longer be located in the service area of a particular policy type (even if that policy is through a national company.)

The only way to know for sure if the location well impact anything is to contact the company directly.

As for why this is sometimes the case, it's because the company is required to file with the state regarding underwriting rules for their membership. They are not allowed to deviate from those rules. So, if the rules on file with the state indicate that the members must live within a specified territory, they are not allowed to make exceptions to those rules.

Answer 7

I've been in healthcare/insurance for a long time, and I've never heard of a situation where insurance could dictate where a person lives. You're right, he might be forced to choose a new physician if he moves to a different area, but I seriously doubt he would lose his coverage.

It would be a good idea for you (or your grandfather) to contact the insurance company and ask this question. No one here can accurately answer it for you.

Answer 8

My experience with Monumental General was as a supplement to medicare. It was not a PPO so there were no restrictions on providers. You could call them, but they probably won't give you specific info on your grandfather's policy. If he would call them, you could get permission from him to make inquiries and find out what type of policy and coverage he has. Maybe he really doesn't want to move....

Here's a link:
http://www.monlife.com/ml/geninsfaqs.asp

Answer 9

Depends a lot on what type of policy he has. Some areas have health policies for seniors where they drop Medicare and enroll in a HMO type policy funded through Medicare; these plans ARE regional and are usually associated with a local hospital group/insurer. In my county, it's called Humana Gold HMO.

So it's possible granddad is not completely crackers, you'll need to check with his plan.

Answer 10

a simple call to the insurance company on a speaker phone with your grandfather with his insurance data handy should get you your answers. privacy laws prohibit some people acting on behave of others with out verbal consent, hence the use of the speaker phone or using 2 extensions on the same line once the call is made.