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Arkansas Risk Pool : Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Arkansas Comprehensive Health Insurance Pool or CHIP.

Regulation establishing risk pool: Arkansas Insurance Department, Act 1995, no. 1339.

Funding: Usually, funds from which the plans are operated come from payments of premiums. In case deficits are incurred, they are adjusted with assessments by board of directors of the Arkansas comprehensive health insurance pool among insurers who are participating.

Plans offered: Arkansas offers one health plan with three different deductibles. One of the major medical plans is CHIP with deductibles of $1000, $5000 and $10000.

Plan benefit: Most of the plans pay 80% of the medical services covered if the services are availed within the network. Coverage for mental disorders and chemical dependency are at 50%. The payment begins after the required annual deductibles are met. The co insurance payable in a year is fixed at a maximum of $1000. As a core benefit, maternity covers are also included.

Arkansas CHIP Policy Details: http://www.chiparkansas.org/pdf/Federally-Resident-Eligible/Policy.pdf.

Maximum benefit limits: The annual and lifetime maximum is fixed at $1 million.

Eligibility: (1) The person must be a resident of Arkansas. (2) He must have had at least 18 months of continuous coverage that expired no earlier than 63 days before enrollment date in the CHIP. (3) The last health insurance should not have been terminated because of fraud or absence of premium payment. (4) The person must have exhausted coverage under COBRA or federal covers if he was eligible for it. (5) The recent covers he had received must have been under government health plans, church plans, group health plans or a plan linked to any of the above.(6) He must not have other personal insurance covers in force the time of applying.

Enrollment periods: The interested person must complete and submit the form before the passing of 63 days since the end of his last coverage. CHIP members who want to change their plans must do so before 15th December in a year. The plan changes become effective from 1st January of the following year. Requests may be made to change to a plan with higher deductibles before the 15th of a month. They become effective on the first of the following month.

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. The plans having lower monthly payments usually have higher deductibles irrespective of other variables.

Premium calculations: The board decides on the monthly premiums and it is usually restricted to 150% of the standard risk rate. This refers to other benefits that individuals in Arkansas can obtain from private health insurance providers.

Pre existing condition waiting period: Pre existing conditions that were diagnosed till six months prior to the start of the coverage are not included in the covers. Option waivers may be purchased and the pre existing exclusion waived. This is valid if the insured had prior insurance cover at least six months prior to the beginning of the coverage. People who want to apply for a waiver cannot be eligible for continued coverage and must be applied for within 30 days of the end of the last coverage.

Contact information: Arkansas Comprehensive Health Insurance Pool, Post Office Box 419, Little Rock, AR 72203, Phone: 1-800-285-6477. Arkansas CHIP Website.

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