Alaska Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Alaska Comprehensive Health Insurance Association / ACHIA

Insurance Regulation Establishing Risk Pool Alaska Legislature

Alaska Comprehensive Health Insurance Association (ACHIA)

In 1992, the Alaska legislature established a health insurance program; Alaska Comprehensive Health Insurance Association (ACHIA); for high-risk individuals who have been denied health coverage by private insurers due to a pre-existing medical condition.

An individual would be eligible for this risk pool if the most recent coverage was under a group health plan; who had at least 18 months of health insurance coverage; who has exhausted any available COBRA coverage; whose most recent coverage was not terminated due to nonpayment of premiums or fraud; who does not have other health insurance coverage; and who is not eligible for other coverage. To receive health coverage from ACHIA, the individual should also be HIPAA-eligible or who are eligible under the Health Coverage Tax Credit federal program..

Funding

Funds to operate ACHIA come from premium payments, but in recent years, these premium payments have fallen way short of the claims ratio. Any deficit incurred by the plan is recouped by assessments that are collected from health insurance companies operating in the State of Alaska.

Plans Offered

There are several different comprehensive health insurance plans available through ACHIA. The primary difference between the plan options available is the deductible amount and the annual-out-pocket maximum limits you select at time of enrollment. For qualified participants under the age of 65, you may choose between six PPO plans and a traditional indemnity plan.

Plan Benefits

Under the PPO plan offered through ACHIA, you can choose from six different deductibles as shown below:

All PPO plans pay 80 % of the allowed charges once you have paid the annual deductible for that plan, as long as you receive treatment either from a preferred hospital or from a hospital that is not preferred when you do not have reasonable access to a preferred hospital. However, if you have reasonable access to a preferred hospital and still choose to receive treatment from another hospital that is not preferred, ACHIA will pay only 60 % of the usual and customary charges. Once you pay your deductible and out of pocket maximum costs, ACHIA will be responsible for paying 100% of your claims.

$1,000 Deductible Non PPO Traditional Plan

ACHIA also offers a non PPO traditional indemnity plan with one deductible of $1,000. This plan pays 80 % of the allowed charges after the $1,000 annual deductible has been satisfied. Here too, once your deductible and out of pocket maximum have been paid, ACHIA will pay 100% of your medical costs.

Maximum Benefit Limits

The maximum payable benefit under ACHIA health coverage is $2,000,000. Your coverage will terminate if you exceed this limit during the length of time you are insured under this program.

Eligibility

Must have lived in the state for at least 9 of the 12 months immediately preceding application; and the person's absence from the state is for medical treatment or education.
Not eligible to be covered under a small employer (2-50 employees) health insurance plan;
Not eligible for medical coverage under a federal or state program including Medicaid or Veteran's benefits, or Native Health Care.
Not eligible for coverage under another health benefit program including a self-insurance plan, health care trust or welfare trust.
Do not have other health insurance coverage in force.
One of the following must apply: received a notice of rejection from another health insurance company in the past 6 months, been offered health insurance with exclusionary riders that significantly reduce your benefits levels or have one of the medical conditions set forth in the ACHIA eligibility guidelines

Enrollment Periods

You may apply for ACHIA coverage at anytime. Policies will become effective on the first of month following date of acceptance. In some cases, your coverage may be made retroactive to the date that your previous group heath insurance terminated.

Premium Payments

Premiums are based only on your health plan selection, your health status and your age.

Premium Calculations

Monthly premiums are limited to 175% of the standard risk rate, which is determined by the board. A standard risk rate is based on what other Alaskans can obtain similar coverage for that if they are eligible for standard issue private health insurance. This policy also includes a 31 day grace period following the premium due date during which the premium can be paid.

Pre-Existing Condition Waiting Periods

There is a six month exclusionary period toward receiving benefits for the treatment of pre-existing medical conditions. This waiting period can be waived if you had previous health insurance that was not voluntarily terminated and you applied for ACHIA coverage within 31 days of the termination date of that previous coverage. The six month waiting period will be reduced by the amount of time that your previous coverage was in effect. The look-back period of pre-existing condition determination is three months.

Alaska Comprehensive Health Insurance Association Contact Information

Alaska Comprehensive Health Insurance Association
P.O. Box 1090
2015 16th St
Great Bend, Kansas 67530
Phone: 888-290-0616

ACHIA Website

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