Health Insurance Risk Pools - Resources and Information
North Dakota Risk Pool - Health Insurance Provided for the Uninsurable
Acronym or name of the risk pool: Comprehensive Health Association of North Dakota or CHAND.
Regulation establishing risk pool: North Dakota legislature-1981. Modifications was added to CHAND in the year 1997 to make it conducive to provisions under HIPAA.
Funding: The programme receives funds from premium payments by members. It is also received from assessments on health plans. Licensed companies are assessed according to the business they’re receiving in the state, usually a minimum of $100000 of premium volume computed annually in the state of North Dakota.
Plans offered: Two medical plans are offered through CHAND. These are PPO plans option 1 and option 2.
Plan benefit: The option 1 PPO plan offers a deductible of $1000. The in network medical cover is offered at a coinsurance level of 20%. The member is expected to pay 20% coinsurance rates for out of network services. The out of pocket maximum is $3000.
Plan benefit: The option 2 plan has a $500 deductible with an out of pocket limit of $3000. The in network medical covers are offered at a coinsurance level of 20%. The member is expected to pay 20% coinsurance rates for out of network services.
Plan benefit: Chiropractic covers may be included with any of these plans.
Plan details: http://www.chand.org/benefits.html
Maximum benefit limits: CHAND offers a lifetime maximum of $1000000 for both the plans.
Eligibility: These are three sets of eligibility criteria for the plan.
Standard eligibility: (1) The person must be a resident of North Dakota for at least 6 months and you are currently residing in the state for at least 183 days. (2) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 6 months. Else, he was offered covers which restricted his benefits for a particular condition. Otherwise, the person has a condition which is certified by a physician as falling under a particular category. (3) You are not receiving benefits from any other plans, state or federal. (4) Your premiums should not be paid by a govt. sponsored programme, health care provider or govt. agency. (5) The person should not have received coverage from CHAND in the last 12 months.
HIPAA eligibility requirements: (a) The person must be a resident of North Dakota for any length of time. (b) The person may not be eligible for Medicare or Medicaid. (c) The person must have at least 18 months of insurance coverage, most recently for a group insurance. (d) The last payment should not have been terminated because of non -payment of premium. (e) You have exhausted your last coverage under COBRA. (f) You have applied for CHAND within 63 days of termination of the last cover. (g) Your premiums are not paid or reimbursed by a government sponsored programme or health care provider.
TAARA eligibility: (1) The person is currently a resident of North Dakota. (2) He is eligible for Federal trade assistance or health insurance tax credit (TAA) or PBGC according to the reform act of 2002. (3) He has had at least three months of prior coverage. (4) The application for CHAND was made within 63 days of termination of the last cover. (5) The person is not a resident of a public institution. (6) He has not received coverage under CHAND in the last 12 months. (7) The person is not eligible for cover under any medical assistance programme of North Dakota.
Enrollment periods: Coverage starts on the first day of the following month after your application is received provided it is received before the cutoff date.
Premium payments: Your age, gender and plan selection determines the premium you pay.
Premium calculations: The rate assigned is 135% of the standard rate charged by insurance companies in the state.
Pre existing condition waiting period: There is a 6 month waiting period for pre existing conditions under these plans. There is also a waiver for persons having HIPAA eligibility.
Contact information: Comprehensive Health Association of North Dakota. 4510 13th avenue S. Fargo, North Dakota 581210001. Phone- 7012772271. CHAND Website.
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