Eligibility

HumanaOne covers individuals from the ages of two weeks to 64 1/2 years, including dependents up to 25 years old (or older if allowed in your state). If you’re a current member, please call customer service for eligibility details or to add a dependent.

Short-Term Medical plans

HumanaOne Short-Term Medical plans offer coverage to applicants who are under 65 years of age and are approved through medical underwriting when applying for a HumanaOne individual health plan. You may be eligible if:

  • You are generally in good health;
  • Your height and weight is proportionate for someone of your age and gender;
  • You are not pregnant or expecting a child (including fathers);
  • You currently have an active or pending policy with Humana.
  • Dependents covered under Short Term Medical plans must be between 30 days old and 25 years (in some states, you may be able to get coverage for dependents over age 25).

Short Term Medical plans are currently available in the following states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Michigan, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, Texas and Wisconsin.

Important information about pre-existing conditions

Although we make every effort to extend coverage to all applicants, not everyone will qualify. People who've been diagnosed with certain conditions may not be eligible for coverage. Coverage may also be denied to people who are undergoing or awaiting the results of diagnostic tests, treatments, surgery, biopsies, or lab work. This pre-existing condition limitation does not apply to covered persons under the age of 19 (as long as they are not covered by a Short Term Medical plan).

In addition, coverage cannot be provided to expectant parents (male or female), to children younger than 2 weeks old, or to adults older than 64 1/2 years. Other eligibility requirements may apply.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) eligibility information

Residents of the states of Arizona, Florida, Nevada, Ohio1, Tennessee, Utah, and Virginia may be eligible for a non-medically underwritten plan under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). To qualify for a non-medically underwritten plan, you must meet specific criteria. If you qualify, you are eligible for guaranteed issue coverage without medical underwriting or pre-existing condition waiting periods.

In order to be considered eligible for a non-medically underwritten plan, you must meet all of the following conditions:

  • You have had at least 18 months of continuous creditable coverage without any significant breaks (greater than 63 days).
  • Your most recent health coverage must have been provided by (or offered in connection with) a group health plan, governmental plan, or church plan.
  • Florida residents only: To qualify, your most recent prior creditable coverage must have been under an individual plan issued in the State of Florida by a health insurer or HMO. This coverage must have been terminated due to one of the following reasons in order for you to be eligible for a non-medically underwritten plan: your insurer or HMO became insolvent, your insurer stopped offering individual coverage in Florida, or you moved out of the service area where the insurer or HMO that provided coverage through a network plan.
  • Your most recent health coverage was not cancelled due to non-payment of premium or because of fraud (Florida residents only: note that your coverage cannot be canceled for nonpayment or fraud if someone other than yourself was responsible for paying your insurance premiums.).
  • You have accepted COBRA or State Continuation coverage if offered, and you have exhausted such coverage.

You are NOT eligible for a non-medically underwritten plan if any of the following apply:

  • You are eligible for coverage under another group plan.
  • You are eligible for Medicare Part A or Part B.
  • You are eligible for a State plan under Title 19 and do not have other health insurance coverage.
    Florida residents only: You may be eligible for guaranteed-issue coverage through a conversion policy or contract offered by an insurer or HMO if you are no longer eligible for employer coverage. Please contact us if you think you may be eligible for a non-medically underwritten plan and would like more information on available plan benefits and rates.