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Maryland Risk Pool : Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: Maryland health insurance plan or MHIP.

Regulation establishing risk pool: Maryland general assembly.

Funding: The funding received is mainly generated from premiums paid by members. It is also generated from tax assessments on hospitals in Maryland.

Plans offered: There are 5 plans to choose from. These are - the EPO network plan, the PPO $200 plan, the $500 PPO plan, the $1000 PPO plan and the High Deductible Health Plan.

Plan benefit: The EPO network plan has no out of pocket maximums, low co payments and no annual deductibles. The PPO plan $200 has an annual deductible of $200, an out of pocket limit of $1000 and a 20% coinsurance for most covered medical services. The PPO plan $500 has annual deductibles of $500, an annual out of pocket limit of $2000 and a 20% coinsurance rate. The PPO plan $1000 has annual deductibles of $1000, an annual out of pocket limit of $2500 and a 20% coinsurance rate. The high deductible health plan charges deductibles of $2500. Once these have been met, most covered expenses are met in full for that calendar year.

Maryland health insurance plan details: http://www.marylandhealthinsuranceplan.state.md.us/

Maximum benefit limits: The maximum lifetime benefit for all plans available through MHIP is $2000000.

Eligibility: (a) The person must be a resident of MD for at least 60 days and one of the eligibility conditions mentioned below. (b) The person must have one of the conditions provided under MHIP presumptive list. (c) The person must have had at least 18 months of cover without a gap lasting more than 63 days. (d) The person should not be eligible for any other coverage. (e) The COBRA coverage must have been ended. (f) The person must be having or must have been offered an insurance plan that restricted his coverage or decreased his benefits because of a particular medical condition. (g) You are the recipient of the Federal Trade Readjustment Allowance or benefits from Trade Adjustment Assistance Programme Or Pension Benefit Guaranty Corporation.

Enrollment periods: The applications received before the 15th of a month are provided cover from the 1st of the following month. You may add dependants to your coverage based on certain conditions during the open enrollment period. Plan choices may be changed during the open enrollment period.

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 200% of the standard risk rate. This refers to benefits that people in Maryland can obtain from other private health insurance providers. The minimum rate is 100%.

Pre existing condition waiting period: There is no exclusion for benefits under the pre existing cause provided proof can be obtained of coverage under a group health plan. The length of time covered in the previous health plan is included in the waiting period.

Contact information: Maryland physician’s care, suite 117. 509 progress drive, Linthicum, MD 2190 2256. Phone: 866 780 7105. MHIP Website.

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