Health Insurance Risk Pools - Resources and Information
Connecticut Risk Pool - Health Insurance for the Uninsurable
Acronym or name of the risk pool: Health Reinsurance Association of Connecticut or HRAC.
Regulation establishing risk pool: Connecticut insurance department under Connecticut Health Care Act Of 1975 chapter 700c, sec 38a-556.
Funding: It is partially funded by payment of premiums from the participants. Deficits are funded through assessment of insurance companies that are operating in Connecticut. There is no provision for tax offsets.
Plans offered: A health insurance company that is operating in Connecticut must offer comprehensive health plans to all residents of the state irrespective of their health condition. This excludes people who are over 65 years of age and people who are eligible for Medicare. Three different plans are offered under HRA. These are individual plans, conversion plans and portability plans. Each of these plans is available with two options. These are Special Health Care (SCHP) and United Health Care PPO plan. Individual and portability plans offer as TAA qualified plan also. HMO coverage is offered in the portability and conversion plans.
Plan benefit: The United Healthcare PPO has an annual deductible of $1500 and pays for 80% of the covered expenses after deductibles have been paid. The out of pocket annually is $7500 for services conducted in network. It is $15000 for out of network services. Separate deductibles are applicable for prescription drugs after co payments have been made. The special health care plan pays for 75% of the reimbursement for Medicare treatments after the annual deductible levels are met. The deductibles are dependent on the level of your income. The out of pocket maximum is $2500 annually. No annual deductibles are applicable for HMO plans. Office visits are paid for at $25 per visit, $250 per day is paid as hospital co payment and fixed co payments are given for prescription drugs.
HRA Brochure: http://www.hract.org/hra/Brochures/brochures.htm
Maximum benefit limits: The maximum lifetime benefits per member for all the plans is $100000. Some of the benefits are restricted by annual maximums.
Eligibility: The type of HRA plans you are applying for determines your eligibility levels. All plans require that you be a resident of Connecticut. The age limit is between 19 and 65.
Individual SCHP plan: (1) Eligibilities are determined by your incomes and your family size. (2) If you are opting for a low income plan, your income should not be greater than 200% of the poverty levels present nationally.
HMO conversion plan: (1) Deductible options available depend on your family size. (2) If you are opting for a low income plan, your income should not be greater than 200% of the poverty levels present nationally.
SCHP conversion plan: (1) You are eligible for it if you are exiting a group plan in the state of Connecticut. (2) You were the member of plan which was not self funded. (3) You have applied within 31 days of the termination of the last group insurance cover. (4) Your previous coverage lasted for at least 12 months. (5) Your income and family size determines the particular deductibles you are eligible for. (6) If you are opting for a low income plan, your income should not be greater than 200% of the poverty levels present nationally.
HMO portability plans: (1) The person must have at least 18 months of prior coverage before applying for the plan with a gap below 120 days. (2) The last insurance cover received must be a group health plan. (3) The application must be received within 63 days of the end of the last group insurance plan. (4) The person must not be eligible for coverage under COBRA regulations.
Enrollment periods: In some cases, the enrollment will depend on the coverage you are applying for under HRA. Individual plans have no restrictions. Conversion plans mandate that the application must be received within 31 days of termination of the previous coverage. Portability plans require a submission within 63 day of the end of the last cover.
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.
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 Connecticut 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: There is a 12 month exclusionary clause for individual plans under the pre existing condition rationale. It is waived if the person qualifies for the conversion or portability plans.
Contact information: Health Reinsurance Association. 100 Great Meadow Rd., Suite 704. Wethersfield, CT 06109. Phone: 800-842-0004. HRAC Website.
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