Idaho Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Idaho Individual High Risk Reinsurance Pool / IIHRRP
Insurance Regulation Establishing Risk Pool
Idaho Statute
Title 41 Insurance, Chapter 45
Idaho Individual High Risk Reinsurance Pool (IIHRRP Plans)
In 2001, the state of Idaho created the High Risk Reinsurance Pool Plans (HRP Plans) to make health insurance coverage available to Idaho residents not covered by employment-related insurance due to pre-existing health conditions.
An individual would be eligible for this risk pool if the most recent coverage was under a group health plan; who had at least 12 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 such as Medicaid or Medicare.
Funding
Funds to operate IIHRP come from premiums collected and assessments on the health insurance companies operating in the State of Idaho.
Plans Offered
Any insurance company offering individual health insurance in the State of Idaho must participate in IIHRRP and make insurance coverage available to persons that are eligible for HIPAA coverage or are uninsurable. Five plan types must be offered that include basic, standard, catastrophic A, catastrophic B and HSA Compatible plans. These “high risk pool policies†or HRP Plans will have the same level of coverage, regardless of which insurance company offers the plan.
Plan Benefits
The Basis HRP plan has a $500 annual deductible for most covered benefits and separate deductibles for maternity and prescription drug benefits. There is a 50% coinsurance and an annual out-of-pocket maximum of $20,000.
The Standard HRP plan has a $1,000 annual deductible for most covered services and a 30% coinsurance up to an annual out-of-pocket maximum of $10,000.
The Catastrophic A Plan has a $2,000 deductible and a 30% coinsurance up to an annual out-of-pocket maximum of $10,000.
The Catastrophic B Plan has a $5,000 deductible and a 20% coinsurance up to an annual out-of-pocket maximum of $10,000.
The HSA Compatible plan has a $3,000 annual deductible per individual ($10,000 for family) and a 60% coinsurance up to a maximum out-of-pocket of $5,000.
Maximum Benefit Limits
The maximum payable lifetime benefit is $500,000 on the Basic plans and $1,000,000 on all other plans. If you reach the maximum lifetime benefit, you may apply for an HRP plan with a different health insurance company if you enroll in the new plan within 63 days.
Eligibility
There are three options for qualifying for coverage under an HRP plan. The list below is a compilation of the requirements from those three options. Not all of these conditions must be met to qualify for any of the options. Refer to the plan brochure above for more details
- Must be a resident of Idaho or a dependent of a resident of Idaho
- You are under the age of 65
- You are not eligible for group health insurance coverage, Medicare or Medicaid
- You do not have other health insurance coverage in force
- You have been denied standard issue health insurance, and then an HRP plan will be automatically offered to you. Or, if that insurance carrier offered you standard coverage at a rate higher than the HRP rate
- You are eligible under federal HIPAA regulations because you have had 18 months of continuous coverage, most recently under a group plan
- You are eligible for a health insurance credit under the Trade Act of 2003
- Your most recent creditable coverage was not terminated based on nonpayment of premiums or fraud
- If you had elected COBRA continuation coverage or a similar state program and exhausted that continuation coverage.
Enrollment Periods
You may apply for IIHRRP 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 on which your previous group health insurance was terminated.
Premium Payments
Premiums are based on your health plan selection, your gender, your age and whether or not you smoke. All insurance companies are required to offer the same coverage at the same premiums amounts.
Premium Calculations
Monthly premiums must be 125% to 150% of the standard risk rate, which is determined by the board by comparing standard issue health insurance rates from insurance companies offering similar type plans in Idaho.
Pre-Existing Condition Waiting Periods
The HRP Plans may exclude pre-existing conditions for 12 months unless the enrollee was previously covered under a group health insurance policy and applied for an HRP plan within 63 days of the termination date of that prior group coverage. The length of time your previous health insurance was in effect will be applied to the one year exclusionary period.
Idaho Individual High Risk Reinsurance Pool Contact Information
The Idaho Department of Insurance
700 W. State Street, 3rd Floor
Boise, ID 83720-0043
Phone: 800-721-3272
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