Arkansas Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Arkansas Comprehensive Health Insurance Pool / CHIP
Insurance Regulation Establishing Risk Pool
Arkansas Insurance Department
Act 1995, No. 1339
Arkansas Comprehensive Health Insurance Pool
The Arkansas comprehensive health insurance pool, created by the Arkansas General Assembly in 1995, provides insurance coverage for Arkansas citizens with high-risk medicals conditions who could not obtain coverage through the individual health insurance market.
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 continuous 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. The Arkansas CHIP provides coverage to the residents who are eligible under the Health Coverage Tax Credit federal program as well as HIPAA-eligible individuals who have exhausted their coverage options in the group market.
Funding
Funds to operate AHIP come from premium payments. The deficit incurred by the pool shall be recouped by assessments apportioned among insurers by the Board of Directors of the Arkansas Comprehensive Health Insurance Pool.
Plans Offered
Arkansas has one health plan available with various deductible options. Arkansas CHIP is a major medical plan with deductibles of $1,000, $1,250 (HSA qualified), $5,000 or $10,000.
Plan Benefits
For most covered services, the plan pays 80% of covered medical expenses if services are received in-network. However, for in-network care, you have to satisfy $1000 out-of-pocket annual maximum deductible. For out-network expenses for medical treatment, the plan pays 60% of the customary charges. Treatment of mental disorders and chemical or drug dependency are reduced to 50%. CHIP begins paying their percentage after you have met your selected annual deductible. Your calendar year co-insurance maximum is $1,000. Maternity coverage is included as a core benefits.
Maximum Benefit Limits
The Arkansas CHIP plan has a lifetime annual maximum benefit of $1 Million.
Eligibility
- Must be a resident of Arkansas for at least 90 days and resident for at least 30 days with evidence of coverage under a Qualified High Risk Pool of another state
- Must have had 18 months of continuous health insurance coverage that expired no longer than 63 days from CHIP 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
- May not currently be covered, or eligible for coverage under a group health plan, Medicare Part A or Part B or an Arkansas Medical Assistance Program
- May not currently have other personal health insurance coverage in force (except while satisfying Arkansas CHIP's pre-existing condition waiting period)
Enrollment Periods
You must complete and submit an application and enroll in Arkansas CHIP coverage within 63 days of the expiration of your prior health insurance coverage. Current members of Arkansas CHIP may request a plan change to decreases their deductible prior to December 15th of each year and plan changes will become effective on January 1st of the following year. A request to change to a higher deductible plan may be made at any time and requests made prior to the 15th of any month will become effective on the first of the following month.
Premium Payments
Premiums are based on your deductible selection, your age, your gender and whether or not you are a smoker. The higher deductible plan options have the lower monthly premiums, regardless of the other variables.
Premium Calculations
Monthly premiums are determined by looking at the standard risk premiums available for plans of similar benefit levels available to healthy individuals in Arkansas. Arkansas CHIP plan premiums may not be higher than 150% of the standard risk.
Pre-Existing Condition Waiting Periods
A pre-existing medical condition that manifested itself within the six month period prior to the effective date of coverage is excluded from covered expenses. An optional waiver may be purchased and the pre-existing condition exclusion will be waived if the insured member had prior health insurance coverage for at least 6 months prior and their coverage was not terminated voluntarily. Persons wishing to apply for the waiver must not be eligible for continuation coverage and must apply within 30 days of the termination date of their prior coverage. The look-back period of pre-existing condition determination is six months.
Arkansas Comprehensive Health Insurance Pool Contact Information
Arkansas Comprehensive Health Insurance Pool
Post Office Box 419
Little Rock, AR 72203
Phone: 1-800-285-6477
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