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	Risk pools - affordable health insurance for medically-uninsurable individuals A risk pool is a state-created, nonprofit association that -- in most states -- does not require tax dollars for its operational purposes. The risk pools are a temporary stopping point for individuals who are denied health insurance for medical reasons. Risk pools often help individuals fill a gap in insurance coverage.
High-risk health insurance plans "risk pools" -- have become an important safety net for individuals who are denied health insurance because of a medical condition. More than 250,000 enrollees in the 33 states which operate risk pools have been provided with comprehensive insurance protection since the first pools were started in 1976. Risk pools provide a vehicle for individuals who, because of their physical condition, are unable to purchase heath insurance at any price. Who is eligible to participate in a state's risk pool? Who is not eligible to participate? Where do risk pools operate? For more information WHO IS ELIGIBLE TO PARTICIPATE IN A RISK POOL? State residency All individuals applying for plan coverage must be residents of that state. State legislation outlines a range of residency requirements for eligibility. Proof of at least ONE of the following: Proof of rejection. Individuals must prove they have been rejected for similar health insurance coverage by at least one insurer. Presently insured with a higher premium. State residents are eligible for plan coverage even though they are currently insured, if their present insurance has a higher premium than offered under their plan. Presently insured with a rider or rated policy. An individual is eligible for plan coverage even though they are currently insured, if their present insurance has a rider attached or is rated. Reciprocity agreements Several (but not all) states include a reciprocity agreement for acceptance into the plan, which means that if an individual has been enrolled under a similar state plan, has met the pre-existing waiting period and has not used up the lifetime maximum, he or she is eligible to apply in another state after meeting the residency requirement. return to top of page WHO IS NOT ELIGIBLE TO PARTICIPATE? Non-residency An individual is no longer eligible for plan coverage if he or she is no longer a resident of the state (although some states have reciprocity agreements). Eligible for Medicare or Medicaid Many of the state plans do not allow an individual to apply for plan coverage if the individual is eligible for, or receiving, Medicare or Medicaid. However, several states have adopted a high-risk plan for Medicare eligible individuals. Termination of Coverage An individual is not eligible for plan coverage if he or she has terminated coverage in the plan unless at least 132 months have elapsed since such coverage. Extended Lifetime Benefit An individual is not eligible for plan coverage if he or she has reached the maximum benefit level authorized by the plan. Inmates An individual is not eligible for plan coverage if he or she is an inmate of a public institution. Specific Exclusions At least one state has excluded coverage for certain diseases or medical conditions. Enrollment Cap Several states have placed an "enrollment cap" on their plans. Under this mandate, the plan will accept only a certain number of individuals into the plan at any one time. Others applying for coverage must be placed on a waiting list for acceptance into the plan. return to top of page WHERE DO RISK POOLS OPERATE? Alabama (for portability only) Alabama Health Insurance Plan Phone 1-800-513-1384 or 334-353-8924 Alaska Alaska Comprehensive Health Insurance Association Phone 1-800-467-8725 or (907) 269-7900 Arkansas Arkansas Comprehensive Health Insurance Plan and here Phone (501) 378-2979 California California Major Risk Medical Insurance Program Phone 1-800-289-6574 or (916) 324-4695 Colorado CoverColorado Phone (303) 863-1960 Connecticut Connecticut Health Reinsurance Association Phone 1-800-842-0004 Florida (not open for new enrollees) Florida Comprehensive Health Insurance Plan Phone (850) 309-1200 Idaho Idaho Individual High Risk Reinsurance Pool (Individual insurance carriers offer high risk individuals four standard plan, reinsured by the state high-risk reinsurance pool) For more information, contact Idaho Department of Insurance (208) 334-4250 Illinois Illinois Comprehensive Health Insurance Plan Phone 1-800-367-6410 or (217) 782-6333 Indiana Indiana Comprehensive Health Insurance Association Phone 1-800-552-7921 or (317) 614-2000 Iowa Iowa Comprehensive Health Association Phone 1-800-877-5156 Kansas Kansas Health Insurance Association Phone 1-800-290-1366 or (316) 792-1779 Kentucky Kentucky Access (866) 405-6145 Louisiana Louisiana Health Plan Phone 1-800-736-0947 or (504) 926-6245 Maryland Maryland Health Insurance Plan 1-866-780-7105 or (410) 576-2055 Minnesota Minnesota Comprehensive Health Association Phone (952) 593-9609 Mississippi Mississippi Comprehensive Health Insurance Risk Pool Phone (601) 362-0799 Missouri Missouri Health Insurance Pool For all but northwest Missouri: 1-800-843-6447 For northwest Missouri: 1-800-645-8346 Montana Montana Comprehensive Health Insurance Association Phone (406) 444-8200 Nebraska Nebraska Comprehensive Health Association Phone (402) 343-3337 New Hampshire New Hampshire Health Plan 1-800-578-3272 for customer service (603) 227-7265 for plan executive administrator New Mexico New Mexico Comprehensive Health Insurance Pool Phone (505) 271-4399 North Dakota Comprehensive Health Association Of North Dakota Phone 1-800-737-0016 or (701) 282-1235 Oklahoma Oklahoma Health Insurance High Risk Pool Phone 1-800-255-6065 or (913) 362-0040 Oregon Oregon Medical Insurance Pool Phone (503) 373-1692 South Carolina South Carolina Health Insurance Pool Phone (803) 788-0222 South Dakota South Dakota Risk Pool (for eligible high risk individuals with 12 months of previous creditable coverage) 1-800-831-0785 Tennessee TennCare Program Contact Tennessee area county medical assistance offices, or Phone (615) 741-8642 Texas Texas Health Insurance Risk Pool Phone 1-888-398-3927 or (512) 441-7665 Utah Utah Comprehensive Health Insurance Pool Phone 1-866-880-8494 or 801-333-5573 Washington Washington State Health Insurance Pool Phone 1-800-877-5187 or (360) 407-0380 West Virginia To become operational in 2005. Contact the West Virginia Insurance Commission for more information. Phone (304) 558-3864 Wisconsin Wisconsin Health Insurance Risk Sharing Plan Phone (608) 264-7733 Wyoming Wyoming Health Insurance Pool Phone (307) 634-1393 return to top of page FOR MORE INFORMATION Following are additional sources of information available from Internet web sites concerning state and federal insurance programs and regulations addressing coverage for high-risk individuals. Georgetown University Georgetown University's Institute of Health Care Research and Policy has established a new website that provides consumer information about how people can access and keep health insurance coverage. Includes information about state programs and regulations for group, individual and HMO coverage for each of the 50 states. Communicating for Agriculture & the Self-Employed A special section in CA's website -which is primarily devoted to agriculture and small business information - provides information on state high risk health insurance plans, including addresses and phone numbers for each of the operating plans.
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