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State by State Guide to Guaranteed Issue Health Insurance in 2012

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

Guaranteed issue individual health insurance exists in all 50 states.  Last year, we posted a comprehensive guide to guaranteed issue health insurance.  This year's guide includes state-specific updates and a brief overview of the types of guaranteed issue health insurance.


HIPAA Plans
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.

Federal Pre-Existing Condition Insurance Plan (PCIP)
Effective March 2010, United States citizens that have been uninsured for at least 6 months may 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. 


State Does the State Go Beyond Federal Requirements? State Risk Pool (if applicable) Plan/Eligibility Notes
Alabama No AHIP AHIP offers two plans to eligible individuals: Traditional Indemnity Plan through Blue Cross Blue Shield and a Managed Care Plan through United HealthCare.
Alaska Yes ACHIA Six (6) PPO plan choices for eligible individuals.  Available to individuals that have had a restrictive rider that substantially reduced coverage.
Arizona No N/A
Arkansas Yes CHIP Individuals eligible through rejection of individual plan due to pre-existing condition or quoted rates greater than 50% of those offered through comparable CHIP plan.  Multiple deductible choices, including HSA-qualified plan.
California Yes MRMIP
California has more options available to residents than most other states.  Click here for a comprehensive guide to HIPAA, Conversion, and MRMIP plans in California.
Colorado Yes CoverColorado Eight (8) plan options, including HSA-qualified plan.  Also eligible for CoverColorado if individual plan quote is higher than the CoverColorado option at the same deductible.
Connecticut Yes HRACT Multiple individual, conversion, and portability plans available.
Delaware No N/A
District of Columbia No N/A  
Florida Yes N/A Eligible individuals are offered choice of two conversion policies that have limits placed on premiums.  The federal fallback offers eligible individuals the choice of any carrier's two most popular plans with no rate restrictions.
Georgia No N/A
Hawaii No N/A  
Idaho Yes HRP Five (5) plan options offered through six (6) different insurance carriers.
Illinois Yes ICHIP Traditional PPO, Medicare, HIPAA, and HIPAA-HTC plans available, including HSA-qualified plan.
Indiana Yes ICHIA
Five (5) plan options.  Pre-existing condition exclusion waiver option available.
Iowa Yes HIPIOWA Five (5) PPO plan options.  Medical condition eligibility options.
Kansas Yes KHIA Four (4) PPO plan options.  Medical condition eligibility options.
Kentucky Yes Kentucky Access Eligible through 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.  Premier Access, Premier Access - Child Only, Preferred Access, and Traditional Access PPO plans available with multiple deductible choices.
Louisiana Yes LHP Four (4) plan options.  Pre-existing condition waiting period of 6-months applies to high risk pool plans.  No pre-existing condition waiting period for HIPAA plans.
Maine Yes N/A All insurance carriers must provide guaranteed issue health insurance to applicants, but may vary premiums based on age, geography, and tobacco use.  Plan premiums may not be increased based on pre-existing conditions, claims history, or any other health-related factor other than age.
Maryland Yes MHIP MHIP Standard, MHIP+, MHIP Federal, and MHIP Federal+ plans available with choice of deductible.  Plus (+) plans available to eligible individuals with limited income.
Massachusetts Yes N/A All insurers carriers must provide guaranteed issue health insurance to applicants.  Open enrollment periods apply.
Michigan Yes N/A Blue Cross/Blue Shield of Michigan provides guaranteed issue coverage to eligible individuals.  HMOs are required to provide guaranteed issue coverage to a limited number of applicants for one (1) 30-day open enrollment period per year.
Minnesota Yes MCHA Six (6) plan options.  Also eligible for MCHA by loss of group coverage, Health Coverage Tax Credit (HCTC) Program, health-related rejection from individual health insurance carrier, or have been treated for a presumptive condition up to 3 years prior to application submission.
Mississippi Yes MCHIRPA Five (5) plan options.  May not change from higher-deductible policy to lower-deductible policy.
Missouri Yes MHIP Five (5) risk pool plan options.  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 or offered individual quote higher than NECHIP.  Multiple deductibles available.
Nevada No N/A All insurance carriers must offer two guaranteed issue plans with limits on price
New Hampshire Yes NHHP Seven (7) plan options. Also eligible for NHHP through pre-qualifying medical condition or if individual quote is higher than NHHP.  
New Jersey Yes N/A All insurers must provide products on a guaranteed-issue basis.
New Mexico Yes NMMIP Six (6) plan options. 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 Four (4) plan options. Automatic enrollment available through presumptive medical condition.  Also eligible if individual quote is higher than Inclusive Health
North Dakota Yes CHAND Four (4) major medical plan options and two (2) Medicare supplement plans. 
Ohio Yes N/A All insurance carriers must offer guaranteed issue coverage, with a cap placed on participation.  Two guaranteed issue products must be made available by the carriers
Oklahoma Yes OHRP Two (2) plan options: Original and Alternate with multiple deductible options. 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 Four (4) plan options. Also eligible for OMIP through qualifying medical condition
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 Seven (7) plan options. Administered by Blue Cross Blue Shield of South Carolina
South Dakota Yes SDRP Seven (7) plan/deductible options. For unisurable child and adults who loss coverage or reached their lifetime maximum benefits (LMB)
Tennessee Yes AccessTN Three (3) plan options with varying deductibles. Also eligible if applicant has one of the specified 50 medical conditions
Texas Yes TXHIP Five (5) plan/deductible options. Also eligible for TXHIP through qualifying medical conditions
Utah Yes HIPUtah Four (4) plan/deductible options. Administered by Select Health of Utah
Vermont Yes N/A All Insurers must Guaranteed Issue all products
Virginia No N/A  
Washington Yes WSHIP Four (4) ppo plans and one (1) standard plan with multiple deductible options. 
West Virginia Yes AccessWV Four (4) plan options. Eligible for AccessWV through recognized chronic or severe medical condition
Wisconsin Yes HIRSP Five (5) plan options including HSA. Eligible for HIRSP through pre-existing exclusion criteria
Wyoming Yes WHIP
Three (3) plan options: Brown, Gold and Catastrophic.  Eligible for WHIP through "presumptive" conditions
  
SRC:  State Health Facts Website



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FAQ: What is Guaranteed Issue Individual Health Insurance?

Note: this should not be taken as tax or legal advice.

Guaranteed issue individual 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.


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FAQ: Can Insurance Companies Charge You More Due to a Pre-existing Condition?

Note: This should not be taken as tax or legal advice.

The answer is yes in most cases.  The real answer depends on two things:
  1. What state you reside in, and
  2. What type of policy you are purchasing

A personal health insurance policy, sometimes called an "individual" or "family" health insurance policy, covers you and your designated family members.  Personal health policies are the fastest growing form of U.S. health insurance. The number of personal health policies grew from 12 million members in 2002, to 24 million members in 2008, and is expected to reach 50 million members by 2012. In contrast, the number of people covered by employer group policies has substantially declined—less than 40% of U.S. small employers now offer group policies.

 

In 46 states, the price of a personal health policy is based on your age and your health at the time of application—but once insured, your premium cannot be increased because you become ill.

Once you obtain a personal health insurance policy, in most states:

  • You and your covered family members are guaranteed the right to renew your personal policy until age 65, independent of employment.
  • Your renewal premium may not be substantially increased due to your claims experience—even if your carrier pays a claim for you of $1 million or more.
  • Your renewal premium will increase when you enter a higher age band (typically every 5 years) or with general medical inflation—based on the claims of a very large group of people in your state who purchased similar personal policies.
  • Some states set limits on annual increases regardless of medical inflation. Depending on your state, you should expect your premium to increase 5% to 15% each year from an initial price much lower than group coverage.  See your local licensed agent for detailed information on your state.
  • If you are healthy and don't like your proposed annual renewal premium, you can always shop around for a new policy just like you do with auto or homeowners insurance. Nationally, more than 300 different carriers, including 76 Blue Cross Blue Shield companies, offer personal polices.

 



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Aetna Offers New Insurance Options for Self-Employed Individuals

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

Aetna recently announced that it will be providing individual health insurance options to more than 200,000 self-employed members of NaseCare.

Many self-employed individuals are unaware that their individual health insurance premiums may be paid for with tax-free dollars.

Click here to learn more.


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States to Determine Essential Health Benefits

Note: this should not be taken as tax or legal advice.

According to a Boston Globe article, the Obama administration has said that it will not set essential health benefits requirements for insurance carriers.

Instead, starting in January 2014, each state will have the power to determine what health benefits must be covered by health insurance policies offered within its borders.  Essential health benefits may vary within 10 broad categories which include preventive care, emergency services, maternity care, hospital and doctors’ services, and prescription drugs.

Opponents of health reform have said that the reform removes the authority of states to regulate health insurance.  This move may be the administration's response to those criticisms.

Chris Jacobs, a health policy analyst for Senate Republicans, feels that the move has only added more uncertainty to health care reform.  According to Jacobs, the new policy “gives states the flexibility to impose more benefit mandates, not fewer,’’ and the result will be higher insurance premiums.

What do you think of of move?



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