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Idaho Individual High Risk Reinsurance Pool

Idaho Risk Pool : Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: Idaho individual high risk reinsurance pool or IIHRRP.

Regulation establishing risk pool: Idaho statute under title 41 insurance, chapter 45.

Funding: It is partially funded by payment of premiums from the participants. Deficits are funded through assessment of insurance companies that are operating in Idaho.

Plans offered: All insurance companies offering health insurance in the state must take part in IIHRRP. They must provide coverage to people who are eligible for coverage under HIPAA o people who are uninsurable. Five types of plans are offered. These are basic, catastrophic A and B and HSA compatible plans. The high risk pools have the same kind of coverage, irrespective of the company offering the plan. They are known as HRP plans.

Plan benefit: The basic plan has a deductible of $500 annually. There are separate deductibles for maternity and prescription drug benefits. The co insurance rate is 50% and the annual maximum limit of benefits is $20000. There is a standard HRP plan with a deductible of $1000 annually for majority of services. The co insurance rate is 30% and the annual out of pocket limit is $10000. The catastrophic plan A has a deductible of $2000 and 30% coinsurance with an annual pocket limit of $10000. Catastrophic plan B contains a deductible of $5000. There is a 20% coinsurance rate and the annual limit is $10000. The HSA plan has a deductible of $3000 and a coinsurance rate of 60% with a maximum limit of $5000.

IIHRRP brochure: http://www.doi.state.id.us/Pubs/high_riskbr.pdf

Maximum benefit limits: The maximum benefits payable for a lifetime is $500000 on basic plans and $1000000 on other plans. If the maximum level is reached, you may apply for an HRP plan from a different insurance company. The new plan must be enrolled in within 63 days.

Eligibility: (1) The applicant has to be a resident of Idaho for a minimum of 6 months. He needs to be a US citizen or a person with legal alien status. (2) The person must have applied for insurance to a carrier and been declined for health reasons. (3) He must have been approved for health insurance but premiums were higher than the minimum offered by HRP. (4) The person must have been eligible for HIPAA as he had continuous coverage under a group plan. (5) The person must be eligible for credit under health insurance as regarding trade act of 2003.

Enrollment periods: IIHRRP coverage may be applied for at any time. The policies become effective on the first of the following month. In certain cases, the policies have a retroactive effect to the date of termination of the last insurance coverage.

Premium payments: Premiums are dependent on the health plan you select. It is also determined by your age, sex and whether you are a smoker. All companies are to offer similar covers for the same premiums.

Premium calculations: The board decides on the monthly premiums and it is usually restricted to a percentage of the standard risk rate. This refers to other benefits that people in Idaho can obtain from private health insurance providers. The rate cannot exceed 150% of the standard risk rate. The minimum rate is 125%.

Pre existing condition waiting period: HRP plans usually exclude covers for pre existing conditions up to a period of 12 months unless the applicant was covered under a group insurance plan and had applied for enrolment within 63 days of termination of the last coverage. The duration of time during which the person received cover is waived from the exclusion period.

Contact information: Idaho Department of Insurance. 700 W. State St., 3rd floor. Boise, ID 837200043. Phone: 8007213272. IIHRRP Website.

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