Alabama Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Alabama Health Insurance Plan / AHIP
Insurance Regulation Establishing Risk Pool
Alabama Department of Insurance
Alabama Health Insurance Plan (AHIP)
The Alabama health insurance Plan is customized for individuals who have exhausted coverage through a group plan, are denied coverage under any other health insurance plan and are not eligible for other group coverage. Created by state law, AHIP is designed to meet the standards of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. If you are eligible for AHIP, you will not have any waiting periods for pre-existing conditions.
To be HIPAA-eligible, a person must have elected and exhausted any available COBRA or state continuation coverage and must not be eligible for Medicare, Medicaid, or group health insurance. HIPAA eligibility lasts for up to 63 days.
Funding
Funds to operate AHIP come from premium payments. Any deficit incurred by the plan is recouped by assessments by AHIP among participating insurers.
Plans Offered
Alabama has two plans available under their Risk Pool. A Traditional Indemnity Plan is offered through Blue Cross and Blue Shield of Alabama and a Managed Care Plan is offered through United HealthCare.
The Traditional Indemnity Plan, administered by Blue Cross and Blue Shield of Alabama, pays a percentage of the cost of covered care from any doctor or hospital you choose. For doctor's office visits, surgery, and other covered medical services, the plan pays 80% of the total costs after an annual medical deductible. The deductible also applies to prescription drugs, with the plan paying 80% for name brand and generic prescriptions purchased from a Blue Cross participating pharmacy. In-hospital care is covered in full at any Blue Cross participating hospital after you meet the inpatient hospital deductible. The traditional indemnity plan two deductible options; $1,000 and $2,500. Premiums could range between $169 to $957 depending on age, sex, smoker or non-smoker, and the plan you choose.
United HealthCare's Managed Care Plan offers healthcare benefits through an exclusive network of hospitals, physicians and other professionals. You choose a primary care physician (PCP) to provide and coordinate your healthcare needs. When you enroll in the Managed Care Plan, your share of the cost of covered care will be set as dollar copayments. There are no hassles regarding filing of claim forms. Benefits are paid only for care coordinated by the PCP. Prescription drugs are limited to $10,000 per member per year. Premiums for Managed Care Plan could vary from $247 to $862 depending on age, sex, and smoker or non-smoker.
The major difference between both the plans is the delivery of the covered care and their premium coverage cost. If you enroll in AHIP's Managed Care Plan you must see a participating provider with United Health Care, while in Traditional Indemnity Plan, you can see any doctor or hospital. However, if the facility or physician is not a Blue Cross provider, you may have to file the claim yourself.
Does AHIP cover
Coverage under AHIP usually includes:
- Doctor Visits
- Routine vision examinations
- Prescription Drugs
- Out-patient and In-patient Hospital Care
- Maternity
- Labs and X-Rays
- Transplants
- Rehabilitation
- Durable Medical Equipment
- Mental Health and Substance Abuse
- Emergency care while away from home
- Facility charges for Outpatient surgery
- Detoxification services
- Ambulance services
- Outpatient Prescription Medication
Plan Benefits
For a summary of benefits, view the plan brochure for the available Alabama Risk Pool plans:
Blue Cross Blue Shield Traditional Indemnity Plan
United HealthCare Managed Care Plan
Maximum Benefit Limits
The Traditional Indemnity Plan has a $1 Million annual maximum and lifetime maximum.
Eligibility
- Must be a resident of Alabama
- Must have had 18 months of continuous health insurance coverage that expired no longer than 63 days from AHIP enrollment date
- Previous health insurance was not terminated due to fraud or non-payment of premium
- Must exhaust state or federal COBRA coverage if it was available to you
- Most recent health insurance coverage was a group health plan, government health plan, church plan, or a health plan connected with any of these types of plans
However, you are not eligible to be enrolled in AHIP if you are covered under any other health plan; under the group health plan through your spouse's employer or if you are eligible for health insurance under Medicaid or Medicare.
Enrollment Periods
You must complete and submit an application and enroll in AHIP coverage within 63 days of the expiration of your prior health insurance coverage.
Premium Payments
Premiums are based on your health plan selection, your age, your gender and whether or not you are a smoker. Premium payments are required on or before their due date, which is the last day of coverage for which the previous premium payment applied. There is a 31 day grace-period on premium payments.
Premium Calculations
Monthly premiums are determined by looking at the standard risk premiums available for plans of similar benefit levels. AHIP plans may not be lower than 125% of the standard risk rates and no higher than 200% of those same rates. Rates are submitted to and approved by the Alabama Insurance Commissioner.
Pre-Existing Condition Waiting Periods
There are no waiting periods. Since prior health insurance coverage is required to enroll in an AHIP plan, pre-existing condition waiting periods do not apply.
Alabama Health Insurance Plan Contact Information
Alabama Health Insurance Plan Administrator
Post Office Box 304900
Montgomery, Alabama 36130
Phone: 1- 866-833-3375, 1-334-263-8311
Fax: 334-240-3059
AHIP Website
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