| Health insurance are basically interesting parts of our | | | | on the open market by competing insurance |
| day-to-day life. It is only that sometimes, we are not | | | | companies, yet because of state law regulations, there |
| aware of this fact! | | | | is a firm cap on the amount of money a patient may |
| Keep your mind open to anything when reading about | | | | be charged for insurance. In general, this cap runs |
| health insurance. Opinions may differ, but it is the base | | | | between 125 to150 percent of the base individual |
| of health insurance that is important. | | | | market rate. While the cap is firm, there is still some |
| A "State Insurance Pool" is a ground-breaking program | | | | elasticity in the rates, and they sometimes may vary |
| that secures insurance benefits for all individuals, even | | | | based on plan participants' ages, or even domicile |
| those who are considered to be high-risk by the | | | | addresses. |
| insurance industry. Quite often referred to as | | | | Quite often copies of rejection notices must |
| "Guaranteed Access Programs", these pools are | | | | accompany an application for coverage under the |
| unique plans created by individual state legislatures in | | | | umbrella of a state insurance pool from state-licensed |
| order to make available a sturdy safety net for those | | | | insurance carriers. Additionally, anyone wishing to take |
| folks to whom the dreaded term "medically | | | | advantage of a state-run plan must be a resident of |
| uninsurable" has been applied. Previously, this | | | | the state in which the plan is offered. In lieu of a |
| determination meant that a person in need of medical | | | | rejection by an insurance carrier, an individual who can |
| care was denied health insurance coverage usually | | | | evidence 18 months or more of uninterrupted health |
| because of a pre-existing health condition. Sadly, it is | | | | care coverage and is considered HIPAA eligible will |
| the patient with such health issues who is in the | | | | quite often qualify for pool coverage. Coverage for |
| greatest need of quality health care, yet quite often | | | | dependants is available as well. |
| unable to afford the treatments because of the | | | | You may be filled with astonishment with the amount |
| financial strain involved. Previously, this has led to | | | | of information we have compile here on health |
| interruptions in medical care for patients who had | | | | insurance. that was our intention, to astonish you. |
| exhausted available COBRA (Consolidated Omnibus | | | | In short, a state insurance pool is of invaluable help to |
| Budget Reconciliation Act of 1985) benefits, and were | | | | anyone who has been denied health insurance |
| now unable to meet steep financial demands from | | | | because of pre-existing conditions or has exhausted |
| care providers. | | | | the allotted time period of COBRA benefits, and needs |
| It is noteworthy that state insurance pools vary from | | | | assistance in receiving needed medical care without |
| state to state; however, they usually function within the | | | | fear of exorbitant out-of-pocket expenses. |
| confines of a state formed not-for-profit alliance, which | | | | As of 2003, thirty-three states offered high-risk pools |
| is governed by a board of directors. In general, this | | | | to their residents. Twelve states have chosen to opt |
| board has representative members from the insurance | | | | out of these programs by providing alternatives. For |
| industry, individual insurance customers, and members | | | | example, the District of Columbia has contracted with |
| of the specific state insurance department. Operating | | | | Carefirst Blue Cross Blue Shield to have an open |
| very much like a clearing house, the board enters into | | | | enrollment period where interested individuals may |
| contracts with an insurance company, and then | | | | purchase coverage regardless of medical conditions, |
| oversees the day to day operations of collecting | | | | and enjoy full benefits after only a short two-month |
| members' premiums, receiving and paying out claims, | | | | waiting period. Rhode Island and Pennsylvania have |
| and answering questions on eligibility for treatment. | | | | contracted with Blue Cross/Blue Shield to offer |
| While coverage is frequently comparable to the | | | | year-round enrollment for otherwise deemed |
| coveted 80/20 major medicals and outpatient | | | | uninsurable patients. |
| coverage, prospective members may still be denied | | | | Interestingly, this health care concept has since been |
| plan benefits because of perceived issues of being | | | | expanded to also apply to hurricane insurance. |
| uninsurable, yet this limitation is often restricted to a | | | | "Windstorm Coverage Pools" are an alternative for |
| 12-month period. Thereafter, acceptance is all but | | | | homeowners who are unable to purchase individual |
| guaranteed. While this is good news for patients | | | | coverage for their residences. Homeowners in a few |
| seeking insurance protection, it is important to | | | | coastal counties of Georgia and New York are even |
| remember that this coverage, while state sponsored, is | | | | to participate in pool coverage for wind and hail |
| not free. As a matter of fact, premium costs are | | | | damage through a program entitled "FAIR" (Fair |
| usually quite a bit higher than comparable plans offered | | | | Access to Insurance Requirement). |