Automatic Acceptance Into Risk Pool?
Q: I am inquiring to find out if an applicant had lived in Mississippi for the past 6 months and had been denied coverage would they automatically apply and be accepted for coverage with the Risk Pool Insurance? I am trying to recruit someone and his wife now has coverage under a group policy but was told that Blue Cross would not cover her in Mississippi even though she is covered under them now in the state of Texas due to the fact that she had a stroke and currently takes medicines. Can you please let me know?
A: OK, let’s recap this to make sure we understand: 1) The wife of your prospective employee is currently insured under a group health plan with Blue Cross in Texas (probably COBRA if they now live in MS?); 2) They relocated to Mississippi 6 months ago, but Blue Cross in Mississippi told her that they would not insure her under an individual health plan because of her health history, 3) You want to know if she will be automatically enrolled in the risk pool in Mississippi?
If our understanding of your question is correct, she will not be automatically enrolled in the Mississippi risk pool when declined coverage by Blue Cross of Mississippi. They may provide her with an application, or the option to enroll in that program, but she will not automatically be enrolled. Not all people want to be enrolled in the risk pool, so the final decision is with the applicant. And, if her current coverage through Blue Cross of Texas is COBRA, she may need to exhaust that before she can go on the risk pool. You would need to verify this with the MS Comprehensive Health Insurance Association. You can get more information about the Mississippi Risk Pool here http://www.doi.state.ms.us/htm_files/mchirpa.html. Can’t you put her on your group health plan as a dependent of her husband if he accepts the job? She should be guaranteed coverage in that case.
Actually we are in the process of recruiting and they still live in Texas and are covered under a group plan. We have checked with BCBS of Mississippi and they would cover her. If they move here and elect COBRA and then cancel after being a resident of Ms. for 6 months, would she be denied through risk pool due to the stroke? We do not offer dependent coverage so therefore she could not be enrolled on our policy. Thank you!
Comment by Alias — October 20, 2006 @ 9:09 am
She would not be denied acceptance to the risk pool because of the stroke. The risk pool is “guaranteed issue”, meaning they do not decline an application because of pre-existing medical conditions. However, she could be denied if she terminates her COBRA voluntarily after 6 months of arriving in MS. Most state risk pools, including the one in Mississippi, are set up to provide health insurance to persons that are uninsurable and have no other options. As long as she is eligible for COBRA, she has other options. She may need to wait until the expiration of the COBRA before applying for the MS risk pool.
I am still unclear on one thing. In your response below, you state “We have checked with BCBS of Mississippi and they would cover her.” From your initial inquiry, I got the impression that they would not cover her because of the stroke. If they will cover her, why is it necessary for her to accept COBRA, or enroll in the risk pool?
Also, she should not make the assumption that COBRA coverage will be available to her through BCBS of Texas if they relocate to MS. They will want to contact BCBS of Texas to confirm this. If they are on an HMO plan, once they move to MS they will be outside of the service area and coverage will terminate. If they lose the COBRA option with BCBS of Texas when they move to MS, they might be eligible for the risk pool and get a waiver on the 6 month residency waiting period because she could be eligible under federal HIPAA regulations (provided they have been on their current group plan for 18 months). I am not 100% sure of this. So, if they find out that the COBRA option is not portable to MS, let me know I can verify this with the MS risk pool for you.
Comment by Site Advisor — October 20, 2006 @ 9:50 am
I am sorry for the confusion. BCBS of Mississippi said they would not cover her due to the stroke. I will have them contact the Texas on COBRA if moving to MS.
Comment by Alias — October 20, 2006 @ 9:52 am
No problem. This health insurance stuff gets confusing. If they learn that they can’t bring the COBRA with them to MS, let me know and I will research other options for you and contact the Mississippi Comprehensive Health Insurance Association to verify eligibility for this situation.
Comment by Site Advisor — October 20, 2006 @ 9:53 am