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West Virginia Risk Pool : Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Access WV.

Regulation establishing risk pool: West Virginia Legislation under House Bill No. 4021.

Funding: The programme receives funds from premium payments by members. Funds are also received from surcharges on hospital bills.

Plans offered: Access WV offers a PPO plan with different types of deductibles the deductibles vary according to individual or family coverage.

Plan benefits: The plan A is a PPO plan with individual deductible of $400 and family deductible of $800. You pay a coinsurance rate of 20% for inpatient services. For out of network services also the coinsurance rate is 20%. The maximum limit for benefits is $2000 for an individual plan and $4000 for a family plan.

Plan b is a PPO plan with individual deductible of $800 and family deductible of $1600. You pay a coinsurance rate of 20% for inpatient services. For out of network services also the coinsurance rate is 20%. The maximum limit for benefits is $2500 for an individual plan and $5000 for a family plan.

Plan c is a PPO plan with individual deductible of $2000 and family deductible of $4000. You pay a coinsurance rate of 20% for inpatient services. For out of network services also the coinsurance rate is 20%. The maximum limit for benefits is $3000 for an individual plan and $6000 for a family plan.

Access WV plan summary: http://www.wvinsurance.gov/accesswv/

Maximum benefit limits: The annual benefit maximum is $200000 and the lifetime maximum is $1000000.

Eligibility: (1) You must have been a resident of state of West Virginia for at a month. (2) You should provide proof of the fact that you had suitable covers for at least 18 months before your application. (3) You may not be eligible for any other cover. (4) You must not be a resident of a mental institution. (5) You have received a notice rejecting your application for insurance because of medical reasons. (6) You were not able to obtain insurance because of a pre existing medical clause. (7) You are eligible under the health care tax credit (HCTC) programme or TAA, ATAA, PBGC or HIPAA. (8) The person has a pre existing medical condition.

Enrollment periods: You can apply for the plan within the fifteenth of a month and the covers become effective the first day of the following month.

Premium payments: Your age, gender, tobacco usage and plan selection determines the premium you pay. Payments can be made through checks, bank withdrawals and money orders. Payments become due on the first of a month.

Premium calculations: The rate capped is at 150% of the standard rate charged by other plans rates are usually higher than other prevalent rates.

Pre existing condition waiting period: A waiting period of 6 months is provided for a person with a pre existing condition.

Contact information: Access WV. C/O PEIA. State Capitol Complex Building 5, room 1001. 1900 Kanawha blvd. E. Charleston, WV 253050710. PH-18664458491. Official Website.

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