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Indiana Risk Pool - Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: Indiana Comprehensive Health Insurance Association or ICHIA.

Regulation establishing risk pool: Indiana Department of Insurance. HIPAA - 1996.

Funding: The funds come from the premiums collected. They are also obtained from assessment of insurance companies operational in Indiana. A partial tax credit offset against premium taxes paid by insurance companies is also included.

Plans offered: Four different comprehensive plans are offered by ICHIA. These are plans 1, 3, 3A and 4. Deductibles, coinsurance and out of pocket maximums vary from plan to plan.

Plan benefit: The plans have a 20% coinsurance rate for in network services and a 40% coinsurance rate for out of network services. For plan 1, the annual deductible is $500 and the out of pocket maximum is $1500. For plan 3, the deductible is $1000 and an out of pocket annual limit of $3000.

ICHIA brochure: http://www.onlinehealthplan.com/

Maximum benefit limits: This is not stated clearly in their website. You need to contact ICHIA directly for more information.

Eligibility: ACHIA has two sets of requirements - general and eligibility. In order to qualify for the plans, all of the general criteria and at least one of the eligibility criteria must be met.

General criteria: (1) The person must be a resident of Indiana for at least 12 months. This is not applicable in case of federally eligible people. (2) The person must not be eligible for Medicaid.

Eligibility criteria: (1) The person must be federally eligible. He should have had health insurance coverage for at least 18 months before applying for ICHIA, with no gap in between greater than 63 days. The coverage must have been under a group health plan and the person must not be eligible for COBRA. The previous cover must not have been ended because of nonpayment of premiums. (2) The person must have received a notice rejecting his application for insurance from an admitted company in the state. (3) He must have been approved for health insurance but premiums were higher than the minimum offered by ICHIA. The person has an individual cover but he is not eligible for cover equaling or exceeding minimum requirements for policies in Indiana.

Enrollment periods: The person has to first apply for Medicare, at least 60 days before applying for ICHIA. He must present an executable verification form for Medicaid. The effective date will be one among the following that occurs later: when the application is approved, the day following termination of the previous cover or within 60 days of receiving the application.

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 Indiana can obtain from private health insurance providers. The rate cannot exceed 150% of the standard risk rate.

Pre existing condition waiting period: The first 3 months following enrollment do not provide benefits for pre existing conditions. This clause is waived if the applicant can provide coverage of continuous coverage that terminated within 6 months preceding the application. Adequate proof of coverage must be provided.

Contact information: ACS healthcare solutions. 4550 victory lane. Indianapolis, IN 46203. Tel. 800 552 7921. ICHIA Website.

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