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eLearning Series:
Your Most Popular Insurance Questions
Answers For Health and Home
Insurance
( 50 articles
in this series )
State Insurance
Pool:
Is This Health Care For You?
A
“State Insurance Pool” is a ground-breaking program that
secures insurance benefits
for all individuals,
even those who are considered to be high-risk by the insurance
industry. Quite often referred to as “Guaranteed Access Programs“,
these pools are unique plans created by individual state legislatures
in order to make available a sturdy safety net for those folks
to whom the dreaded term "medically uninsurable" has
been applied. Previously, this determination meant that a person
in need of medical care was denied health insurance coverage
usually because of a pre-existing health condition. Sadly,
it is the patient with such health issues who is in the greatest
need of quality health care, yet quite often unable to afford
the treatments because of the financial strain involved. Previously,
this has led to interruptions in medical care for patients
who had exhausted available COBRA (Consolidated Omnibus Budget
Reconciliation Act of 1985) benefits, and were now unable to
meet steep financial demands from care providers.
It
is noteworthy that state insurance pools vary from state
to state; however, they usually function within the confines
of a state formed not-for-profit alliance, which is governed
by a board of directors. In general, this board has representative
members from the insurance industry, individual insurance customers,
and members of the specific state insurance department. Operating
very much like a clearing house, the board enters into contracts
with an insurance company, and then oversees the day to day
operations of collecting members’ premiums, receiving and paying
out claims, and answering questions on eligibility for treatment.
While
coverage is frequently comparable to the coveted 80/20
major medicals and outpatient coverage, prospective members
may still be denied plan benefits because of perceived issues
of being uninsurable, yet this limitation is often restricted
to a 12-month period. Thereafter, acceptance is all but guaranteed.
While this is good news for patients seeking insurance protection,
it is important to remember that this coverage, while state
sponsored, is not free. As a matter of fact, premium costs
are usually quite a bit higher than comparable plans offered
on the open market by competing insurance companies, yet because
of state law regulations, there is a firm cap on the amount
of money a patient may be charged for insurance. In general,
this cap runs between 125 to150 percent of the base individual
market rate. While the cap is firm, there is still some elasticity
in the rates, and they sometimes may vary based on plan participants’
ages, or even domicile addresses.
Quite often copies of rejection notices must accompany an
application for coverage under the umbrella of a state insurance
pool from state-licensed insurance carriers. Additionally,
anyone wishing to take advantage of a state-run plan must be
a resident of the state in which the plan is offered. In lieu
of a rejection by an insurance carrier, an individual who can
evidence 18 months or more of uninterrupted health care coverage
and is considered HIPAA eligible will quite often qualify for
pool coverage. Coverage for dependants is available as well.
In short, a
state insurance pool is of invaluable help to anyone who
has been denied health insurance because of pre-existing
conditions or has exhausted the allotted time period of COBRA
benefits, and needs assistance in receiving needed medical
care without fear of exorbitant out-of-pocket expenses.
As of 2003, thirty-three states offered high-risk pools to
their residents. Twelve states have chosen to opt out of these
programs by providing alternatives. For example, the District
of Columbia has contracted with Carefirst Blue Cross Blue Shield
to have an open enrollment period where interested individuals
may purchase coverage regardless of medical conditions, and
enjoy full benefits after only a short two-month waiting period.
Rhode Island and Pennsylvania have contracted with Blue Cross/Blue
Shield to offer year-round enrollment for otherwise deemed
uninsurable patients.
Interestingly, this health care concept has since been expanded
to also apply to hurricane insurance. “Windstorm Coverage Pools”
are an alternative for homeowners who are unable to purchase
individual coverage for their residences. Homeowners in a few
coastal counties of Georgia and New York are even to participate
in pool coverage for wind and hail damage through a program
entitled “FAIR” (Fair Access to Insurance Requirement).
Click here to to view health insurance quotes, compare plans side-by-side and apply for the most affordable health insurance within your budget. I did this myself (June 17, 2011) to change my health insurance policy. Saved me $84 per month (or $1,008 per year). It's my SolveYourProblem recommendation.
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by SolveYourProblem.com : 2005
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