Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Dec 12, 2019

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As a general proposition, a health insurance company cannot cancel an individual’s coverage under a health insurance policy or plan arbitrarily. However, a health insurance policy can be canceled (rescinded) if there are material omissions or misrepresentations made by the insured or member in the application for health insurance coverage.

Situations that Warrant Cancellation

Health insurance policies or plans can be canceled (rescinded) if there are material omissions or misrepresentations made by the insured or member in the application for coverage. When you apply for health insurance and sign an application, you answer questions and provide information about the medical history of anyone who will be covered under the health insurance policy or plan. In doing so, you must reveal any serious medical condition or treatment that might reasonably affect the decision by the insurer or plan to undertake the risk associated with providing the coverage.

Even if the health insurance policy or plan is issued and premiums are paid, the health insurer or health service plan can cancel or rescind the policy later if they discover that the policyholder or insured did not disclose in the application significant medical history. The result is that the insurer or plan does not pay for the care that was rendered, the health insurance policy is canceled and the premiums that were paid on the policy are returned to the policyholder less a reasonable cost of insurance associated with the period of time during which the policy was in force.

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Reduction or Elimination of Benefits

A limited form of cancellation can occur involving reduction or elimination of health insurance benefits. Other than a requirement of reasonable notice, insurers and plans may reduce or eliminate benefits, unless the contract or health service plan prohibits it or limits it. In some states there is a major exception known as “vesting,” which means that if the insured or member already has a claim or has received benefits for a particular injury or illness, they may continue to receive the health insurance benefit even if it is otherwise canceled.

For questions about whether a particular a health service plan or policy can be cancelled by the health insurance company, or if facing cancellation of health insurance coverage, contact an experienced attorney for assistance.