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Health High Risk Insurance Pools

Health High Risk Insurance Pools

35 American states have designed health insurance high-risk pools. These pools are created to provide healthcare coverage to the individuals who are ineligible buying individual health insurance. The eligibility is determined on the basis of the health status of an individual.

What are health high risk insurance pools or HRPs?

HRPs are basically state-operated non-profit organizations that mostly have contract with a private health insurance provider to control the pool.

Whom these HRPs provide coverage to?

HRPs provide healthcare coverage through an array of health plans to the individuals who don't have insurance or otherwise denoted as medically uninsurable.

Health high risk insurance pools offer different health insurance plans that differ within the pools and state-by-state. Like private individual health insurance plans, risk pool plans also sometimes implement waiting periods for covering pre-existing conditions to deject clinically uninsurable people from previous health insurance till they need healthcare.

There are some specific aspects of state health high-risk insurance pools. And, these aspects include enrollment, funding and benefits.

HRP Funding

Most of the health high-risk pools are operated at loss because of high healthcare costs basically incurred by the medically uninsurable people. Premiums for the health high-risk pools plans are thus higher than the plans offered to insurable healthy people. But, these premiums are restricted to limit the costs of enrollees and so not enough covering the enrollee healthcare claims costs. Therefore, these pools increase their revenues through different funding methods, like state revenues and assessment on health insurance providers.

Federal grant is also entitled to build and finance HRPs. Operations Grants, Seed Grants, Bonus Grants are some from federal grant programs. Each grant is meant for individual purpose. Department of Health and Human Services or HHS along with The Centers for Medicare & Medicaid Services or CMS controls this program.

HRP Enrollment

As of 2008, there were a total of 199,418 enrollees along with their dependants in 34 health high-risk insurance pools. Almost 4 million people are eligible to get into a HRP, according to their health status and pre-existing medical conditions. In 2008, the annual average deductible for popular plan provided by each of the HRPs was 1593 USD, which was higher than deductible among employer-funded insurance plans.

HRP Benefits

People covered under plans offered by health high risk insurance pools enjoy much better deductible than that of the individuals covered under employer-funded insurance plans. As of 2008, roughly 63% of the total enrollees in the popular HRP plans got deductibles of 1000 USD or even higher; while 88% of the enrollees in employer-funded insurance plans got deductibles of below 1000 USD or simply no deductible.

Some important data on HRPs (as of 2008)

  • HRP management board included members from medical providers, state government, health insurance carriers, employers and enrollees.
  • Total claims compensated by health high risk insurance pools were almost 2 billion. And, it was nearly 95% of the total HRP expenses.
  • Average claims for every enrolled individual totaled 9,437 USD.
  • Insurance carrier assessment contributed 23% of HRP funding and 54% was funded by premium revenue.
  • Health high-risk insurance plans were granted a total of about 286 million USD in federal grants

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