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Kentucky Risk Pool - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Kentucky Access.

Regulation establishing risk pool: Kentucky legislature under Kentucky revised statute chapter 304. 17b.

Funding: The funds come from the premiums collected. They are also obtained from assessment of insurance companies operational in Kentucky. An additional source is the state tobacco tax.

Plans offered: Three medical insurance plans can be found through the Kentucky access programme. The traditional access plans is a fee for service plan. The premier access plan and the preferred access plans are PPO plans.

Plan benefit: The annual deductible for the traditional access fee for service plan is $400. There is a 15% coinsurance for covered services within the network. The out of patient coinsurance rate is 20%. The out of pocket limit is $1500 after deductibles have been paid.

There are three deductibles for the Premier Access PPO plan. These are $700, $1500 and $2250. The coinsurance rate for most of the in network services is 35%. The rate is 40% for out of network services. The out of pocket limit is $2500 for the deductible limit of $700; it is $3000 for the $1500 plan and $4500 for deductible plan of $2250.

The Preferred Access PPO Plan: this plan has two deductibles annually. These are $750 and $1500. There is a 40% coinsurance for most covered costs. The maximum limit is $3000 for the deductible plan of $750 and $5000 for the deductible plan of $1500.

Plan brochure:

Maximum benefit limits: Unlimited lifetime benefits are provided for the Traditional Access Plan. It is also unlimited for the $400 deductible plan. There is a $2000000 maximum for all other plans. The preferred access plan offers $2000000 maximums for all options of deductibles.

Eligibility: (1) The person must be a resident of Kentucky for at least 12 months and satisfy one of the eligibility conditions mentioned below. (2) The candidate must be federally eligible i.e. they must be eligible under HIPAA regulations. (3) Insurance rejection category consists of those individuals who have been refused insurance covers by a company offering similar plans in Kentucky. (4) Those who have been offered insurance at rates higher than the prevalent one fall under the category of high premium rate.(5) High cost condition category includes those individuals who have an illness listed under the eligibility guidelines.(6) The GAP category includes individuals enrolled in the state Guaranteed Acceptance Programme. (7) The spouse or children category includes the legal dependants of the insured.

Enrollment periods: Applications may be presented at any time. If approved, coverage starts on the first of the following month if it is before the cutoff date. If you are eligible under federal guidelines, your application must be produced within 63 days of the end of the last cover. You may also opt for a later effective date before the expiry of 3 months from the date of 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 rate cannot exceed 175% of the standard risk rate. This refers to benefits that people in Kentucky can obtain from other private health insurance providers.

Pre existing condition waiting period: The exclusion period for pre existing conditions is of 12 months. This is waived under exceptions. Consult the brochure for details.

Contact information: Kentucky access, PO box 33707. Indianapolis, IN 46203 0707. Phone 866 405 6145. Kentucky Access Website.

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