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Small Business Employee Benefits and HR Blog

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

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.state by state guide to guaranteed issue

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  

The Comprehensive Guide to the Small Business HRA
  
SRC:  State Health Facts Website

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