Private Health Insurance: Access to Individual Market Coverage May Be Restricted for Applicants with Mental Disorders Page: 4 of 32
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Accountability * Integrity * Reliability
United States General Accounting Office
Washington, DC 20548
February 28, 2002
The Honorable Richard Durbin
Subcommittee on Oversight of Government Management,
Restructuring, and the District of Columbia
Committee on Governmental Affairs
United States Senate
The Honorable Edward M. Kennedy
Committee on Health, Education, Labor, and Pensions
United States Senate
About 19 percent of American adults suffer from some type of mental
disorder each year. Most are nonsevere in nature but about 5 percent of
adults have serious mental disorders. While many of these adults have
access to employer-sponsored group health coverage or public programs
such as Medicare or Medicaid, some without such coverage may seek to
purchase health insurance directly in the individual market. This market
provided about 12.6 million Americans with their sole source of health
coverage in 2000. States are the primary regulators of individual health
insurance, and most states allow individual market insurance carriers to
medically underwrite-that is, evaluate applicants' health status and
possibly deny coverage, offer more limited benefits, or charge higher
premiums to applicants with any health condition, including mental
Because of concerns that individuals with mental disorders may face
problems obtaining coverage for themselves and their families in the
individual health insurance market, you asked us to examine carriers'
underwriting practices in this market segment. In particular, you asked us
to examine the following questions:
1. To what extent do states require individual market carriers to
guarantee access to coverage and limit premiums for applicants and
their families with mental disorders?
2. How do individual market carriers' coverage and premium decisions
affect applicants with mental disorders, and how do these decisions
compare to those for applicants with other chronic health conditions?
GAO-02-339 Access to Health Insurance for Applicants with Mental Disorders
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United States. General Accounting Office. Private Health Insurance: Access to Individual Market Coverage May Be Restricted for Applicants with Mental Disorders, report, February 28, 2002; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc292222/m1/4/: accessed October 23, 2018), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.