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The Way High Risk Pools Work

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The Way High Risk Pools Work

The Way High Risk Pools Work

For most of the Americans, increasing costs of health insurance is becoming the most important matter of concern. Employers' group health insurance plans among those few that help people reduce financial burden related to health care. But, the problem arises when you don't belong to a group insurance plan or have a chronic health condition. Probably you will be refused by the insurance providers getting healthcare coverage or offered a plan with unreachable deductible.

Dependant on the state you reside, you may find a group health insurance risk pool which is meant for you. Health high-risk insurance pools are state-operated programs created to offer healthcare coverage to those people who are refused to get a private medical insurance plan because of a pre-existing health condition. Below, we will discuss on what are high-risk pools and the way high risk pools work.

Health high-risk pools that started in 1976 in Minnesota are now available in 34 states with over 180,000 Americans enrolled nationally. Such pools are basically used as the last option or to get healthcare coverage when somebody is between jobs. There are many who could not live devoid of the coverage such pools offer. By collecting 'uninsurable' individuals in a single group, states can offer healthcare at a high cost.

Who are defined as 'uninsurable'?

Health high-risk insurance pools are specifically designed to help those uninsurable people who can afford health insurance, but are refused by the private health insurance companies due to a pre-existing health condition. And, this is the way high risk pools work. Health insurance companies can refuse to provide health care coverage because of the following reasons.

  • Manageable chronic diseases
  • Fatal diseases
  • Frequent routine check ups

Many of the people enrolled to high-risk pools suffer from type 1 diabetes, leukemia or cirrhosis or otherwise have got organ transplantation. However, just having any of such conditions is not all to qualify for a health high-risk insurance pool; every state has got its own eligibility criteria. Usually, the things you should furnish for getting coverage under high-risk pools are mentioned below:

  • testimony of rejection by a health insurance company
  • testimony of state-residency
  • testimony of a refused claims for treatment of a pre-existing health condition

People who are not qualified for such health high-risk insurance pool may include convicts and individuals who are qualified for Medicaid and Medicare or otherwise taking advantage of the COBRA.

High risk pools however do not essentially provide any guarantee of healthcare coverage. Under certain conditions these pools can not provide any coverage. This also differs from state-wise. The states normally restrict the number of individuals in a group. In such cases, it provides a waiting list.

And, this is the way high risk pools work.

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