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Dipping into your State Health Insurance Pool – What Are The Requirements?

December 6, 2011 by  
Filed under Finance

State health insurance is a branch of health insurance that is for high-risk individuals with chronic and/or pre-existing conditions. Most common diseases to see on this type of insurance are HIV, AIDS, kidney disease, obesity, and diabetes. This high-risk pool is designed to act as a safety net to offer some form of insurance to these people but for a hefty premium. This program has fewer participants due to the cost. This plan is not low-income friendly. Rates can be as much as double what the normal market value for health insurance is. The pool does tend to offer better benefits but is definitely geared to those people that truly afford insurance. So, most people who fall under this category and require this type of plan are likely to be uninsured due to not being able to afford a plan. This plan is last resort for persons with such illnesses that land them for emergency or hospital care frequently, and it that case pays for itself quickly. Some of the few persons who cannot afford this are lucky enough to have a spouse in the work place that is able to add them to their policy from their employer, these plans cannot discriminate due to chronic or long-term illnesses. The State Health Insurance Pool knows its rates are high, and claims so are medical costs for the chronically ill. They have to charge more to be able to get ahead and stay afloat.

Most risk pools are nonprofit associations ran by the state. Usually they do not use taxes to operate their business. Most persons requiring this type of service usually are filling up the gap in cost of what their normal plan won’t cover or is a temporary pit stop till they can find a plan that accepts them at a lower cost. The people who qualify for this type of coverage must be a resident of the state they are applying in. Most states require you live there for at least six months and some up to one full year before reaching residency status. You also need one of several possible documents from other insurance companies. You will need proof of rejection from at least one company denying them benefits similar to the ones being asked for. You can use proof of insurance with a higher premium as well. You may also be eligible if you can show proof of insurance with a rider or rated policy. Any of the above mentioned could get you approved to apply for the risk pool in the state you reside in. A reciprocity agreement is when a person who is eligible for the plan and is currently on a similar plan, met the waiting period quota, and not used up the lifetime maximum benefits can still be eligible if they move to another state after they meet the residency requirement. Not all states, but most, have this agreement included into their plan.

There is a list of those who are not eligible in the high-risk pool besides non-residents. You are no longer eligible if you move to another state but if you have a reciprocity agreement, you can become eligible in the state you now reside after residency has been established. Most people who are eligible or receive Medicaid or Medicare are also not eligible. Many states do have a high-risk plan for Medicare eligible persons, but if you receive or could receive Medicaid than you don’t qualify. If a person has terminated their coverage in another plan and less than 132 months have passed they are not eligible for the pool till that time is up. Those who have used their maximum lifetime benefits for their plan are also not qualifying. Inmates of a public institution are also not eligible for the risk pool. Other specific exclusions can include state decided specific diseases or medical conditions that they just don’t want to cover. An enrollment cap may also be in affect so only a specific amount of persons may be actively enrolled at any given point of time. All other applicants who are eligible will be placed on a waiting list till there is an opening. There seem to be a higher list of those who don’t qualify then who do for this high-risk benefit that costs an arm and a leg anyway.

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