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Oregon Risk Pool : Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: Oregon Medical Insurance Pool or OMIP.

Regulation establishing risk pool: It was established by the Oregon legislature in 1989. The senate bill 123 modified the original.

Funding: The programme receives funds from premium payments by members. It is also received from assessments on health plans of companies and reinsurance companies. Oregon also offers a premium subsidy programme to people with low incomes.

Plans offered: Four medical plans are offered under OMIP. All are PPO plans. The four plans are PPO medical plan 500, medical and portability plan 750, medical plan 1000 and medical portability plan 1500.

Plan benefit: PPO plans offer deductibles of $500, $750, $1000 and $1500. 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. The medical and portability plan 750 has an annual deductible of $750 and the out of pocket maximum is $3000. The $1000 deductible has an out of pocket limit of $4000. The portability plan 1500 offers a $1500 annual deductible and a coinsurance rate of 30%. The maximum out of pocket is $6000.

OMIP plan details: http://www.oregon.gov/DCBS/OMIP/

Maximum benefit limits: All the plans offer a maximum lifetime benefit of $2000000.

Eligibility: The applicant must be a resident of Oregon and meet one of the criteria below:

Medical eligibility requirements: (1) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 6 months. (2) You are paying premiums at a rate that is more than the rate for OMIP because of a health condition. (3) The person was offered a health plan by a private carrier but with a restrictive waiver for a particular medical condition. (4) Health insurance was offered to the individual but his choices were limited because of his medical condition. (5) You have one of the medical conditions included in the plan brochure.

Portability requirements: (1) You are a resident of Oregon and are continuing as such. (2) You have had at least 18 months of coverage and the last was group coverage. (3) The group plan has been terminated and you have ended coverage under COBRA. (4) No COBRA coverage was continued through the last plan. (5) The plans have ended within the last 63 days of filing of application.

Enrollment periods: Applications are accepted for these plans throughout the year. Once approved, coverage begins on the first day of the following month, provided the date falls before the cutoff date. If applying for portability coverage, your coverage can start the day following the end of the last cover.

Premium payments: Your age, gender and plan selection determines the premium you pay. If a family is applying for the plan as a whole, the rate applicable for the oldest member will determine the rates of the rest of the family.

Premium calculations: The rate capped is 125% of the standard rate charged by insurance companies in the state. For HIPAA rates, 100% of those charged by private carriers are allowed.

Pre existing condition waiting period: There is a 6 month waiting period for pre existing conditions under the medically eligible persons. There is also a waiver for persons having portability eligibility.

Contact information: Oregon Medical Insurance Pool, C/O Regence Blue Cross Blue Shield of Oregon MS. E10K. P.O box 1271. Portland- OR 972071271. OMIP Website.

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