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High risk pools - Some more questions

High risk pools - Some more questions

A high risk pool is an organization that is created by the state based on principles of non profit. They offer comprehensive health benefits to people with health problems which are pre existing. Many state pools have now become fallback options for people changing from a group plan to an individual one. Here are a few questions you might have regarding the pool.

How do these pools work?

These are basically state sponsored programmes provided to high risk individuals who are eligible and who do not have group insurance. They normally have a contract with the carrier to administer the paperwork required for the pool. As a result, your documents may not reveal that you are a part of the pool. You can either apply directly to the pool or go through an agent. You will receive a choice of plans and other information just as you do with any other health plan.

How much do I have to pay for high risk pool insurance?

You definitely have to pay more than you do for traditional pools. It is only fair. After all, these are given to people who are considered to be uninsurable. There is usually a cap at 125% to 150% of the standard rate. Letís see an example. If you had to pay $100 a month for standard policy and you are a healthy male of about 30 years, you would have to pay around $125 to $150 in a month if you are part of the high risk pool for the same coverage.

The rates you pay are dependent on your age and the place you stay. The rates are more or less affordable throughout the country as they are linked to the individual markets.

What do I do if my state does not provide high risk pools?

Twelve states in the country use other methods of securing insurance for these people. These may include coverage through a designated carrier or ensuring that policies are issued at least for a part of the year without considering the medical condition of the person. States may also provide coverage through a reinsurance pool. There are five other states where covers are not provided for this group. High risk people may have a tough time securing health covers in these states.

What are the non eligible categories for a high risk pool?

The following categories of people are not covered by the high risk pools:

  • Nonresident: an individual who is not a resident of the state cannot be eligible for the pool.
  • Medicare or Medicaid eligible: most states do not allow members who are receiving Medicare or Medicaid benefits, or are eligible for them, to enroll in these pools. Many states do provide high risk plans for people who are Medicare eligible.
  • Termination of provided benefits: if the person has already ended coverage under the plan, he or she is not eligible for it anymore. This also applies if 132 months have passed since the last cover was terminated.
  • Extended lifetime benefits: once the maximum benefit levels have been reached, the applicant is no longer eligible for covers under this pool.
  • Specific exclusions: certain medical conditions are specifically excluded from coverage by the pool.
  • Enrollment cap: in many states, there is a cap on the number of enrollments in the plans. This means that at any given time, the number of members in the pool is limited. Those who have not yet enrolled are usually placed on a waiting list.

How can I get more information?

You can get more information from your state insurance commissioner or go online to find out if you are eligible for the pool. You can also find out other details about the plans on offer and the costs associated.

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