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Iowa Risk Pool - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Iowa comprehensive health insurance or HIPIOWA (Health Insurance Plan of Iowa).

Regulation establishing risk pool: Iowa state legislation under chapter 514 E, Iowa comprehensive.

Funding: It is partially funded by payment of premiums from the participants. HIPIOWA plans are funded through assessment of insurance companies that are operating in Iowa.

Plans offered: It offers plan A, a Medicare PPO type of plan. It is available for people under 65 enrolled in Medicare. It is secondary to plans B, C, D and PPO plans. It is offered to people who are not eligible for Medicare.

Plan benefit: The Medicare Carve out Plan A has annual deductibles of $1000 for in network services and $2000 for out of network services. The maximum out of pocket limit is $5000 for out of network treatments and $2500 for in network ones. For Plan B, the annual deductible for in network services is $1000 and for out of network services, the deductible is $2000 the out of pocket limits for plan b are $2500 for in network and $5000 for out of network services. Plan C has annual deductible of $1500 for in network services and $3000 for out of network services. Out of pockets are $3000 and $6000 respectively for in network and out of network services. Plan D has deductibles of $2500 for in network services and $5000 for out of network services. The out of pocket limit for the former is $5000 and $10000 for the latter. For all plans, the coinsurance rate is 20% for in network services and 40% for out of network services. The benefit level varies from 60% to 80% depending on whether you are availing services in network or out of it. Deductibles for the last 90 days of a calendar year can be carried over to the next year. Midlands Choice Provider Network provides the choice of providers.

HIPIOWA plan brochure:

Maximum benefit limits: The maximum benefit in dollars provided under HIPIOWA is $3000000.

Eligibility: (1) The person must be a resident of Iowa for at least 60 days and one of the eligibility conditions mentioned below. (2) Medical eligibility category - (a) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 9 months. (b) You were served notice substantially reducing your benefits which made the plan less advantageous to you as compared to others. (c) The premium rate charged was more than that of other similar plans. (d) The last cover was terminated involuntarily. (3) Medical condition category: the person must have one of the conditions provided under HIPIOWA presumptive list. (4) Federal eligibility criteria: (a) The person must have had at least 18 months of cover without a gap lasting more than 63 days. (b) The last coverage must have been a group plan, govt. health plan or a church plan. (c) The person should not be eligible for any other coverage. (d) The person may not be eligible for Medicare or Medicaid. (e) The COBRA coverage must have been ended. (5) Basic and Standard eligibility criteria: the person who has a Basic and Standard Policy is eligible.

Enrollment periods: Completed and approved applications, received by the 20th> of a month are put into effect on the first of the following month. If you are eligible under federal guidelines, your application must be produced within 63 days 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 Iowa can obtain from private health insurance providers. The rate cannot exceed 150% of the standard risk rate. In calculating the rates, the top five insurance companies operating in the state are considered.

Pre existing condition waiting period: The first 6 months following enrollment do not provide benefits for pre existing conditions. The plan brochure provides details on the exceptions.

Contact information: HIPIOWA. P.O. Box 1090. Great Bend, KS 67530. Phone: (877) 793-688. Fax: (620) 792-0535. HIPIOWA Website.

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