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High risk pools - Frequently Asked Questions

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High risk pools - Frequently Asked Questions

Individuals qualifying for high risk pools not only feel the pinch of premiums that are ever increasing, they also have to find a company that is willing to cover them. If you feel that you qualify for such a group, it will be an arduous task trying to locate a company that is willing to take you on. Once you do, be ready to delve a little deeper into your pocket for the premiums. As insurance companies do not like to invest in high risk individuals, the premiums are usually steep. You may have a number of queries regarding the entire process. Go through the questions below to get a rough idea of the process.

Who is a high risk individual?

This basically refers to an individual with a pre existing medical condition or illness which would make him more prone to applying for claims. These are individuals who are usually turned down by insurance companies or are charged high premiums for normal covers.

What can I do if I’m categorized as a high risk individual?

If you have looked around for a suitable plan and have been rejected or charged exorbitant rates, your best bet is to go for a state sponsored pool.

What is the meaning of a state sponsored pool?

These refer to a group of insurers who are willing to provide health insurance to people who are denied insurance by private carriers. To find out whether this facility is offered in your state, contact your state insurance department.

Do I qualify for the high risk pool?

You need to be a resident of the state in question. If you are planning to shift to another state, the cover will not migrate with you. You have to apply for cover under that state’s pool.

You need to produce proof for the fact that you were denied insurance by a carrier or were paying premiums higher than the pool in question.

In some states, you may receive covers if your current provider has refused you claims because of a pre existing clause. But you must remember that if you apply under this clause, you may have a waiting period clause.

How do these pools work?

These are basically pools that are self funded and private insurance that are state organized. For most states, these are independent bodies having their own boards and administrators. In some states, they function as part of the insurance department of the state. You get a choice of plans. Your paperwork etc is usually taken care of by a provider. Once you are enrolled, you can avail benefits like a normal consumer.

What coverage choices do I get?

These are similar to traditional plans. You usually get a major comprehensive plan with a choice of deductibles. The common ones are PPO plans but you also get indemnity and HMO or HSA plans. Most pools also offer you maternity and mental health covers. They also have efficient disease management programmes.

Will I receive cover for all medical conditions immediately?

Like other normal insurance, they do have pre existing condition waiting periods. This is done to prevent adverse selections. But if you have had previous covers, it is included in the waiting period. The credit usually depends on how long you had the covers.

You can go online and lookup you states plans and eligibilities. For further questions and answers, contact your insurance department.