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