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Tuesday, March 15th, 2011

State-by-State Guide to PCIP (Federal Health Insurance Risk Pool)

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

In July, 2010, the health reform bill created the Pre-Existing Condition Exclusion Plan (PCIP) to provide health insurance coverage to uninsurable citizens. Currently, 24 states (including District of Columbia) administer their own PCIP program. The federal government and HHS run the program on behalf of the remaining states.

Eligibility for PCIP is based on the following criteria:

Legal citizen of the United States
Uninsured for 6-months prior to application
Denied an individual health insurance plan due to a pre-existing condition

A state-by-state summary is provided below for your convenience. Please add questions and suggestions via the comment section.

State	Federal or State Run?	State Program Name (if applicable)	Additional PCIP Notes^*
Alabama	Federal	N/A
Alaska	State	ACHIA-FED	$1500 deductible plan, rates from $468/mo (25 yr old) to $1310/mo (55 yr old)
Arizona	Federal	N/A
Arkansas	State	CHIP
California	State	California PCIP	$1500 deductible plan, rates from $180/mo (25 yr old) to $564/mo (55 yr old)
Colorado	State	GettingUSCovered	$2500 deductible plan, rates from $184/mo (25 yr old) to $486/mo (55 yr old)
Connecticut	State	CT PCIP Plan	$1250 deductible plan, rates from $285/mo (25 yr old) to $628/mo (55 yr old)
Delaware	Federal	N/A
District of Columbia	Federal	N/A
Florida	Federal	N/A
Georgia	Federal	N/A
Hawaii	Federal	N/A
Idaho	Federal	N/A
Illinois	State	IPXP	$2000 deductible plan, rates from $135/mo (25 yr old) to $368/mo (55 yr old)
Indiana	Federal	N/A
Iowa	State	HIPIOWA-FED	$1000 deductible plan, rates from $261/mo (25 yr old) to $435/mo (55 yr old)
Kansas	State	PCIP-KS	$2500 deductible plan, rates available via phone at 1-877-505-0511
Kentucky	Federal	N/A
Louisiana	Federal	N/A
Maine	State	DirigoChoice	Choice of three deductible amounts from $1250 - $2500
Maryland	State	MHIP	$1500 deductible plan, rates from $141/mo (under 30) to $354/mo (65 and over)
Massachusetts	Federal	N/A
Michigan	State	HIP Michigan	$1000 deductible plan, rates from $241/mo (25 yr old) to $563/mo (55 yr old)
Minnesota	Federal	N/A
Mississippi	Federal	N/A
Missouri	State	MHIP	Choice of three deductible amounts from $1000 - $5000 with plan rates from $271/mo (25 yr old) to $570/mo (55 yr old)
Montana	State	MAC Plan	$2500 deductible plan, rates from $219/mo (25 yr old) to $516/mo (55 yr old)
Nebraska	Federal	N/A
Nevada	Federal	N/A
New Hampshire	State	NHHP-FED	$1000, $2000, and $2500 deductible plan options, rates from $159/mo (25 yr old) to $520/mo (55 yr old)
New Jersey	State	NJ Protect	Several plan options with plan rates from $252/mo (25 yr old) to $440/mo (55 yr old)
New Mexico	State	NMMIP	$500, $1000, and $2000 deductible plan options, rates from $168/mo (25 yr old) to $409/mo (55 yr old)
New York	State	NY Bridge Plan	Zero deductible plan with standardized premium rates ranging from $362/mo to $421/mo, depending on geographic location
North Carolina	State	Inclusive Health	Choice of four deductible amounts from $1000 - $4500 with plan rates from $109/mo (25 yr old) to $276/mo (55 yr old)
North Dakota	Federal	N/A
Ohio	State	Ohio Risk Pool	Choice of $1500 or $2500 deductible amounts with plan rates from $130/mo (25 yr old) to $358/mo (55 yr old), depending on geographic location
Oklahoma	State	OHRP	$2000 deductible plan, rates from $137/mo (25 yr old) to $395/mo (55 yr old)
Oregon	State	Oregon Medical Insurance Pool	Choice of four deductible amounts from $500 - $1500 with plan rates from $266/mo (25 yr old) to $557/mo (55 yr old)
Pennsylvania	State	PA Fair Care	$1000 deductible plan, with average rate of $283/mo
Rhode Island	State	PCIPRI	$1000 deductible plan, with plan rates from $231/mo (25 yr old) to $520/mo (55 yr old)
South Carolina	Federal	N/A
South Dakota	State	SD Federal Risk Pool	$2000 deductible plan, with plan rates from $231/mo (25 yr old) to $535/mo (55 yr old)
Tennessee	Federal	N/A
Texas	Federal	N/A
Utah	State	Federal HIPUtah	Choice of four deductible amounts from $500 - $5000 with plan rates from $137/mo (25 yr old) to $271/mo (55 yr old)
Vermont	Federal	N/A
Virginia	Federal	N/A
Washington	State	PCIP-WA	Choice of $500 or $2500 deductible amounts with plan rates from $221/mo (25 yr old) to $606/mo (55 yr old)
West Virginia	Federal	N/A
Wisconsin	State	HIRSP-Federal	Choice of four deductible amounts from $500 - $3500 with plan rates from $113/mo (25 yr old) to $340/mo (55 yr old)
Wyoming	Federal	N/A

SRC: Pre-Existing Condition Insurance Plan Website

*Monthly premium rates are estimates, please obtain unique individual quote based on your needs

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Posted by JD Cleary

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Monday, August 2nd, 2010

Tax Free Individual Health Insurance in Texas Using HRAs, POPs and Payroll Reimbursement Arrangements

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

HRAs, POPs and Tax-free Individual Health Insurance are 100% allowed in Texas if administered the correct way.

This blog post will address the concerns raised by the infamous 2006 Texas Department of Insurance (DOI) Bulletin B-0028-06.

The person (Bill Bingham) responsible for this bulletin has since retired. In 2006 (when this bulletin was written), Mr. Bingham strongly believed, that:

“If an employer reimburses insurance premiums through an HRA or allows pre-tax deductions from employer paid salaries through a cafeteria plan, the arrangement is an employee welfare benefit plan providing medical care to employees through the reimbursement of premiums or otherwise."

However, ERISA has a safe harbor regulation that declares that ERISA does not apply to arrangements where employers make no contributions to the purchase of group or group-type insurance but merely make such insurance available to employees should they voluntarily choose to enroll in such coverage (see 29 C.F.R. § 2510-3-1(j)).

According to the 2006 Bulletin B-0028-06:

"TIC §1501.003 states that an individual or group health benefit plan[1] is a small employer health benefit plan subject to Insurance Code Chapter 1501 if it provides health care benefits covering two or more eligible employees of a small employer and
   (1) The employer pays a portion of the premium or benefits;
   (2) The employer or a covered individual treats the health benefit plan as part of a plan or program for purposes of Section 106 or 162 of the Internal Revenue Code; or
   (3) The health benefit plan is an employee welfare benefit plan under 29 C.F.R. Section 2510.3-1(j).

Texas Insurance Code §1501.004 contains similar provisions for a large employer.

...

Under TIC §§1501.003(3) and 1501.004(3), if a health benefit plan is an employee welfare benefit plan under 29 C.F.R. Section 2510.3-1(j), the plan is subject to the group health provisions of TIC Chapter 1501.”

Individual policies reimbursed by ZanePOP cannot be made subject to this regulation because, with ZanePOP:

The employer does not pay a portion of the premium or benefits for the individual health insurance policy;
The employer/employees do not treat a specific individual health insurance plan as a part of a plan or program for purposes of Section 106 or 162; and
The individual plan is not an employee welfare benefit plan under 29 C.F.R. Section 2510.31-1(j).

The non-applicability of TIC Section 1501.003 to individual policies reimbursed by ZanePOP should be straightforward. Please post questions in the comment section.

Similarly, individual policies reimbursed by ZaneHRA cannot be made subject to this regulation because, with ZaneHRA:

The employer does not pay a portion of the premium or benefits for the individual health insurance policy;
The employer/employees do not treat the individual health insurance plan as a part of a plan or program for purposes of Section 106 or 162; and
The individual plan is not an employee welfare benefit plan under 29 C.F.R. Section 2510.31-1(j).

The non-applicability of TIC Section 1501.003 to individual policies reimbursed by ZaneHRA should be straightforward, but I will go into more detail here because this is where most of the confusion exists.

The ZaneHRA itself is the "Plan", not the health care items reimbursed by the "Plan". In other words, ZaneHRAs are qualified ERISA- and HIPAA-compliant employee welfare benefit plans. However the medical items (e.g. pharmacy, insurance policy costs, doctor visits, etc.) for which each employee chooses to seek reimbursement from their ZaneHRA, are not part of an employee welfare benefit plan.

The federal government has guidelines for employers who want to allow insurers or their representatives access to their employees without triggering ERISA plan status and the associated liabilities. ZaneHRA is designed to comply with these guidelines.

Compliance includes the following restrictions on the actions of employers:

Employers must not be involved in employees' decision to purchase individual health insurance, or their decision on which insurer or plan to use. They must not get involved in any negotiations with an insurance carrier over price or benefits of individual health insurance plans, and must not provide employees with claim forms or other materials related to their individual health insurance policies.
Employers may not directly pay premiums on individual health insurance policies. They must not receive any compensation from an insurance carrier in connection with an employee's individual health insurance policy. Employers must not become involved in any claim dispute between an employee and an insurance carrier; all inquiries must be directed to the insurer.

To comply with point (1) above, while still making contributions to an HRA that can reimburse for individual health insurance premiums, employers must follow these additional guidelines:

Employers must not pressure employees to use the money in their HRA to pay for individual insurance coverage. Employers may require HRA participants to have health insurance coverage to participate in their HRA provided this requirement is waived for participants medically unqualified to obtain health insurance (e.g. rejected, uprated, excluded).
In addition to reimbursing for health insurance premiums, employers should also allow the use of HRA funds for qualified medical expenses.
Employers must limit their role to simply reimbursing qualified medical expenses as directed by the ZaneHRA plan.

Click here to read more about tax free health insurance.

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Posted by Rick Lindquist

Tags: individual insurance, hra, POP, texas, tax-free

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Wednesday, October 21st, 2009

Coverageforall.org Provides Consumers Free State-by-State Health Insurance Assistance

The Foundation for Health Coverage Education (FHCE) provides several excellent resources for Health Insurance on the coverageforall.org website.

On the website, a consumer may take Eligibility Quizzes to exhaust all health insurance options, call the uninsured help line for 24/7 support, view a state specific Health Care Options Matrix Guide, and even apply for public health insurance programs.

For your convenience, I have linked directly to each state's matrix guide below. Let me know what you think.

Source: coverageforall.org

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Posted by Rick Lindquist

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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.

If you have any tips or suggestions for this blog, send an email to blog@ZaneBenefits.com and let us know. We always appreciate feedback

We also run a company called Zane Benefits where we're doing everything we can to help America out of the current healthcare mess.

If you want to learn more about how Zane Benefits helps companies with their benefits, or you're interested in working with us, visit the Zane Benefits website.

Everything you need to know about health insurance

State-by-State Guide to PCIP (Federal Health Insurance Risk Pool)

Tax Free Individual Health Insurance in Texas Using HRAs, POPs and Payroll Reimbursement Arrangements

Coverageforall.org Provides Consumers Free State-by-State Health Insurance Assistance