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Monday, March 7th, 2011

State-by-State Guide to Guaranteed Issue Individual Health Insurance Plans in 2011

Note: None of this should be taken as legal or tax advice.

Guaranteed issue health insurance refers to health insurance that does not involve the process of medical underwriting and must be provided to an eligible applicant regardless of the applicant’s age, gender, or any pre-existing health condition prior to enrollment. In five U.S. states (MA, ME, NY, NJ, VT) medical underwriting is not allowed - that is, all individual market insurance companies must provide guaranteed issue individual health insurance plans. In the remaining states, where medical underwriting is allowed in the individual market, the availability of guaranteed issue health insurance varies by state.

Effective January 1st, 2006, federal law (HIPAA) requires all states to provide guaranteed individual health plans to residents who meet certain eligibility criteria. Individuals who meet this criteria are commonly referred to as "HIPAA-eligible" (or "federally HIPAA-eligible") individuals. If an individual meets the federal definition of "HIPAA-eligible", then the state must provide that individual with guaranteed issue individual health insurance. Typically, states provide these plans through a state risk pool. However, some states transfer this responsibility to private insurance companies.
Most states go far beyond this federal mandate and offer guaranteed issue individual health insurance plans to all of their uninsurable residents.

Effective in 2010, if an individual cannot obtain health insurance for a period of 6 months, he or she can purchase a guaranteed issue individual health insurance plan through the temporary federal risk pool (PCIP).

A state-by-state summary is provided below for your convenience. In the coming weeks, we will be adding state-specific resource pages at www.zanebenefits.com. Please add questions and suggestions via the comment section.

State	Does the State Go Beyond Federal Requirements?	State Risk Pool (if applicable)	Additional Eligibility Notes
Alabama	No	AHIP
Alaska	Yes	ACHIA	Medical eligibility for ACHIA includes substantial reduction of coverage due to restrictive riders (pre-existing exclusions)
Arizona	No	N/A
Arkansas	Yes	CHIP	Also eligible through rejection of individual plan due to pre-existing condition or quoted rates greater than 50% of those offered through comparable CHIP plan
California	Yes	MRMIP	In California, there are three different ways to obtain guaranteed issue individual health insurance (assuming you do not already qualify for Medicare, Medicaid or another program): 1) HIPAA Plans, 2) Conversion Policies, and 3) MRMIP
Colorado	Yes	CoverColorado	Also eligible for CoverColorado if individual plan quote higher than CoverColorado option at same deductible
Connecticut	Yes	HRACT
Delaware	No	N/A
District of Columbia	No	N/A	Carefirst BCBS Open Erollment HMO Plan available year round, max 2,500 enrollees
Florida	Yes	N/A	Risk pool closed to new enrollment. Individual carriers must offer two most popular plans on guaranteed issue basis.
Georgia	No	N/A	Georgia Assignment System provides qualifying individuals with guaranteed issue plans.
Hawaii	No	N/A
Idaho	Yes	N/A	High Risk Reinsurance Pool Plan (HRP Plan) must be offered by carriers
Illinois	Yes	ICHIP	Also eligible if rejected for individual health insurance, or physician's letter confirming Presumptive Medical Condition. Also eligible if offered health insurance at premium rates higher than ICHIP
Indiana	Yes	ICHIA	Also eligible if rejected fpr health care coverage, premium rates higher than ICHIA, and dependent eligibility by meeting age limitation requirements. Newborn children automatically covered for first 31 days after birth
Iowa	Yes	HIPIOWA	Medical eligibility through addition of pre-existing exclusion or medical condition from specified list.
Kansas	Yes	KHIA	Medical condition eligibility includes pre-existing exclusion and quoted premium rates higher than similar KHIA plan
Kentucky	Yes	Kentucky Access	May become Kentucky Access eligible through Federal eligibility, insurance rejection, higher quoted premium rate, high cost condition, GAP eligible, spouse or child of a Kentucky Access enrolee, or a child unable to obtain individual coverage
Louisiana	Yes	LHP	Must provide two written denials of individual coverage or provide a letter from an insurance agent stating that two insurance carriers will deny applicant due to pre-existing condition. Pre-existing condition waiting period of 6-months for LHP
Maine	Yes	N/A
Maryland	Yes	MHIP	Also eligible through qualifying medical condition
Massachusetts	Yes	N/A	All Insurers must Guaranteed Issue all products
Michigan	Yes	N/A	Blue Cross/Blue Shield of Michigan provides guaranteed issue coverage
Minnesota	Yes	MCHA	Also eligible for MCHA by loss of group coverage, Health Coverage Tax Credit (HCTC) Program, health-related rejection from individual health insurance carrier, have been treated for a presumptive condition up to 3 years prior to application submission
Mississippi	Yes	MCHIRPA
Missouri	Yes	MHIP	Also eligible for MHIP if individual health insurance premiums are greater than 300% of standard individual premiums
Montana	Yes	MCHA	Also eligible for MCHA if premium rate is greater than 150% of average premium rate used to calculate MCHA premium rates. Eligible if applicant possesses a qualifying health condition
Nebraska	Yes	NECHIP	Also eligible for NECHIP if applicant has one of the specified medical conditions listed
Nevada	No	N/A
New Hampshire	Yes	NHHP	Also eligible for NHHP through pre-qualifying medical condition
New Jersey	Yes	N/A	All Insurers must Guaranteed Issue all products
New Mexico	Yes	NMMIP	Also eligible for NMMIP through qualifying medical condition
New York	Yes	N/A	All Insurers must Guaranteed Issue all products
North Carolina	Yes	Inclusive Health	Automatic enrollment available through presumptive medical condition
North Dakota	Yes	CHAND
Ohio	Yes	N/A	Select insurance carriers must offer guaranteed issue coverage, with a cap placed on participation. Two guaranteed issue products must be made available by the each carrier
Oklahoma	Yes	OHRP	Also eligible for OHRP through medical condition, premium rate increase greater than OHRP rate, or involuntary termination of an individual health insurance plan
Oregon	Yes	OMIP
Pennsylvania	No	N/A	Blue plans must provide guaranteed issue plans
Rhode Island	Yes	N/A	Individual market insurers must guarantee issue of all products with 12 months of creditable coverage, provided that the applicant is not eligible for alternative group coverage, Medicare or any other state insurance plan
South Carolina	Yes	SCHIP
South Dakota	Yes	SDRP	Carriers must issue standard and basic plans up to a specified percentage of their overall business
Tennessee	Yes	AccessTN	Medically uninsurable eligibility through pre-existing condition from list
Texas	Yes	TXHIP	Also eligible for TXHIP through qualifying medical conditions
Utah	Yes	HIPUtah
Vermont	Yes	N/A	All Insurers must Guaranteed Issue all products
Virginia	No	N/A	Carefirst BCBS Open Erollment PPO Plan available year round
Washington	Yes	WSHIP	All carriers must guarantee issue all products to medically qualified individuals that are determined to be too healthy for coverage under WSHIP
West Virginia	Yes	AccessWV	Eligible for AccessWV through recognized chronic or severe medical condition
Wisconsin	Yes	HIRSP	Eligible for HIRSP through pre-existing exclusion criteria
Wyoming	Yes	WHIP

SRC: State Health Facts Website

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Posted by JD Cleary

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Thursday, September 10th, 2009

A Guide to State Guaranteed Coverage in California

Note: None of this should be taken as legal or tax advice.

In a recent post, we provided a state-by-state guide to guaranteed issue individual health insurance. While this guide may be helpful as a national overview, it does not provide state-specific information on th policies or application requirements. Since regulation of insurance is a state responsibility, the process for obtaining guaranteed issue health insurance varies from state to state. The purpose of this post is to provide a concise guide to purchasing guaranteed issue individual health insurance in California. If you have questions, please leave a comment.

In California, there are three different ways to obtain guaranteed issue individual health insurance (assuming you do not already qualify for Medicare, Medicaid or another program):

HIPAA Plans (All individual market carriers are required to offer these plans to eligible individuals)
Conversion Policies (An individuals previous group insurance carrier is required offer these plans to eligible individuals)
MRMIP (The state offers these "state risk pool" plans to eligible individuals)

HIPAA Plans

California's HIPAA program is different from many states because the state risk pool (MRMIP) is not the insurer of last resort for HIPAA eligibles. California meets its HIPAA requirement using the "Federal Fall-back" method. Under this HIPAA approach, all individual market carriers in California are required to offer a HIPAA policy to eligible individuals. If you qualify for a HIPAA plan, you cannot be denied insurance because of pre-existing conditions. For applicable rates and policy options, see the Department of Managed Health Care website.

Conversion Policies

In California, an employee may also be eligible to purchase a guaranteed issue individual "conversion" policy if they lose their group health insurance. This is called a conversion plan because the employee converts from the group policy to an individual policy. When an employee's group plan ends, the group carrier must offer eligibile employees (employees with 3 months creditable coverage) an individual "conversion" policy. If you qualify for a conversion plan, you cannot be denied insurance because of pre-existing conditions. For applicable rates and policy options, see the Department of Managed Health Care website.

MRMIP

MRMIP (Major Risk Medical Insurance Program) is California's state risk pool for people with health problems who are not able to buy individual health insurance and are not eligible for the above HIPAA or Conversion plans. Californians qualifying for the program participate in the cost of their coverage by paying premiums. The State of California supplements those premiums to cover the cost of care in MRMIP. Because of funding limitations, MRMIP does sometimes have a wait list. For applicable rates and policy options, see the MRMIP website.

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Posted by Rick Lindquist

Tags: Insurance, individual insurance, HIPAA, california

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Thursday, August 13th, 2009

A State-by-State Guide to Guaranteed Issue Individual Health Insurance

Note: None of this should be taken as legal or tax advice.

In my previous post, I wrote about the 1996 HIPAA legislation and its requirement that states offer guaranteed-issue health insurance to all of its HIPAA-eligible residents. I also mentioned that 40 states go far and above what HIPAA mandates. These states offer forms of guaranteed issue individual health insurance (e.g. risk pools) to their medically uninsurable residents, regardless of the HIPAA requirements.

Health insurance sold on a guaranteed issue basis cannot reject applicants based on health or risk status. In a few states (e.g. New Jersey) all individual market insurers must guarantee issue all individual plans. In others states guaranteed issue requirements are much less restrictive.

If you have questions, please comment.

State	> HIPAA?	Risk Pool	Notes
Alabama	No	AHIP
Alaska	Yes	ACHIA
Arizona	No	N/A
Arkansas	Yes	CHIP
California	Yes	MRMIP
Colorado	Yes	CoverColorado
Connecticut	Yes	HRACT
Delaware	No	N/A
D.C.	No	N/A
Florida	Yes	N/A	Eligible individuals, who are uninsured for 6 months, can buy a guaranteed issue limited benefit policy through the Cover Florida Health Care Program
Georgia	No	N/A
Hawaii	No	N/A
Idaho	Yes	N/A	Individual market insurers must guarantee issue standardized policies to the medically uninsurable. These policies are called High Risk Pool Policies.
Illinois	Yes	ICHIP
Indiana	Yes	ICHIA
Iowa	Yes	HIPIOWA
Kansas	Yes	KHIA
Kentucky	Yes	Kentucky Access
Louisiana	Yes	LHP
Maine	Yes	N/A	All Insurers must Guaranteed Issue all products
Maryland	Yes	MHIP
Massachusetts	Yes	N/A	All Insurers must Guaranteed Issue all products
Michigan	Yes	N/A	BCBS of Michigan is Insurer of last resort
Minnesota	Yes	MCHA
Mississippi	Yes	MCHIRPA
Missouri	Yes	MHIP
Montana	Yes	MCHA
Nebraska	Yes	NECHIP
Nevada	No	N/A
New Hampshire	Yes	NHHP
New Jersey	Yes	N/A	All Insurers must Guaranteed Issue all products
New Mexico	Yes	NMMIP
New York	Yes	N/A	All Insurers must Guaranteed Issue all products
North Carolina	Yes	Inclusive Health
North Dakota	Yes	CHAND
Ohio	Yes	N/A	Individual Market Insurers must guarantee issue standardized policies on a periodic basis.
Oklahoma	Yes	OKHRP
Oregon	Yes	OMIP	Individual Market Insurers must guaranteed issue portability policies to individuals with 6 months creditable coverage
Pennsylvania	No	N/A
Rhode Island	Yes	N/A	Individual market insurers must guarantee issue all products with 12 months of creditable coverage, provided that the applicant is not eligible for alternative group coverage, Medicare or any other state insurance plan
South Carolina	Yes	SCHIP
South Dakota	Yes	SDRP
Tennessee	Yes	AccessTN
Texas	Yes	TXHIP
Utah	Yes	HIPUtah
Vermont	Yes	N/A	All Insurers must Guaranteed Issue all products
Virginia	No	N/A
Washington	Yes	WSHIP
West Virginia	Yes	AccessWV
Wisconsin	Yes	HIRSP
Wyoming	Yes	WHIP

SRC: State Health Facts Website

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Posted by Rick Lindquist

Tags: individual insurance, HIPAA

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Tuesday, August 11th, 2009

The Best Kept Secret of the 1996 HIPAA Legislation

Note: None of this should be taken as legal or tax advice.

This post is about possibly the greatest secret of the 1996 HIPAA legislation, and maybe even individual health insurance. That is, federally mandated guaranteed-issue individual health insurance in all 50 states.

The federal law passed in 1996 (HIPAA) requires all states (beginning in 2006) to offer state-guaranteed individual health policies to individuals who meet certain eligibility criteria. Individuals who meet this criteria are commonly referred to as "HIPAA-eligible" (or "Federally-eligible") individuals. Forty (40) states go far beyond this federal mandate and offer state-guaranteed personal health policies to all of their residents (we will save this discussion for later post). This focuses entirely on an individual's eligibility requirements for federally mandated guaranteed-issue individual health insurance in all states.

Background:

Individual health insurance is less expensive for healthy employees in most states because individual carriers in those states are able to underwrite individuals based on their health condition. Subsequently, only 83% (nationally) of applicants medically qualify for personal health policies. The 17% who may not qualify based on underwriting may qualify for individual insurance (regardless of health conditions) as a HIPAA-eligible individual. This is all thanks to the Clinton Administration's passing of the 1996 HIPAA legislation.

Nestled deep inside the 100+ pages of 1996 HIPAA legislation are two sections (Section 2741 and 2744) that require states to make available individual health insurance to all HIPAA-eligible residents on a guaranteed issue basis (i.e. no denial of coverage).

Ok, so who qualifies?

People are HIPAA-eligible and are guaranteed the right to purchase individual insurance coverage if they meet the following criteria:

they have had at least 18 months of previous health insurance coverage without a break in coverage lasting 63 days or more;
their most recent period of coverage was under an employer-sponsored group plan, a church plan, or a government plan;
they did not lose insurance coverage due to fraud or failure to pay premiums;
they are ineligible for or have exhausted their COBRA or similar state, or federal continuation coverage; and
they are not eligible for Medicaid, Medicare, or any other employer-sponsored plan.

Some Examples of "HIPAA-eligible" Individuals

1. An employee for a 15-person company loses his job. Because the company has less than twenty (20) employees, his employer does not provide COBRA. Because he has 18 months prior creditable coverage and is not eligible for Medicaid or Medicare, he is HIPAA-eligible.

2. A 100-person company drops their group plan. All employees who have 18 months prior coverage (without a lapse of greater than 63 days) become HIPAA-eligible, assuming they are not eligible for another insurance plan (e.g. Medicaid, Medicare, or any other employer-sponsored plan).

Want more information?

I recommend reviewing the following for solid background on HIPAA and its HIPAA-eligibility requirements:

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Posted by Rick Lindquist

Tags: individual insurance, HIPAA

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Clarifying Health is a blog about health insurance, health benefits, and everything else related to how Americans pay for medical expenses.

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Everything you need to know about health insurance

State-by-State Guide to Guaranteed Issue Individual Health Insurance Plans in 2011

A Guide to State Guaranteed Coverage in California

A State-by-State Guide to Guaranteed Issue Individual Health Insurance

The Best Kept Secret of the 1996 HIPAA Legislation