Indiana Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Indiana Comprehensive Health Insurance Association / ICHIA
Insurance Regulation Establishing Risk Pool
Indiana Department of Insurance
Health Insurance Portability and Accountability Act of 1996
Indiana Comprehensive Health Insurance Association (ICHIA)
In 1982, the state of Indiana established a high risk pool known as the Indiana Comprehensive Health Insurance Association (ICHIA) offers coverage to individuals who are unable to purchase an individual health insurance coverage because they have pre-existing health conditions. To be eligible, you must apply for individual coverage and be rejected by at least one health insurance company before you become eligible got ICHIA unless you are HIPPA-eligible. People who are fall under the category of HIPPA-eligible include those people who have had at least 18 months of continuous creditable coverage and those people who have exhausted all COBRA continuation coverage.
Funding
Funds to operate ICHIA come from premiums collected and assessments on the health insurance companies operating in the State of Indiana, along with a partial tax credit offset against insurance premium taxes paid by the insurance companies.
Plans Offered
ICHIA offers four different comprehensive PPO plans, Plan 1, Plan 3, Plan 3A and Plan 4. Each plan has its own deductible, coinsurance and out-pocket maximum.
Plan Benefits
All 4 plans have a 20% coinsurance in-network and a 40% coinsurance out-of-network. Plan 1 has a $500 deductible and an annual out-of-pocket maximum of $1,500. Plan 3 has a $1,000 deductible an annual out-of-pocket maximum of $3,000. Plan 3A has a $1,500 deductible and an annual out-of-pocket maximum of $4,000. Plan 4 has a $2,500 deductible and an annual out-of-pocket maximum of $5,000.
Maximum Benefit Limits
To get information regarding the maximum lifetime benefit, contact ICHIA.
Eligibility
ICHIA has two general requirements and three eligibility categories. To qualify for health insurance under ICHIA, you must meet all of the general requirements and at least one of the eligibility categories.
General Requirements
- You must be a resident on Indiana for at least 12 months (not applicable if you are federally eligible)
- You are not eligible for Medicaid
Eligibility Categories
- You are "federally eligible" if you have had previous creditable health insurance for at least 18 months prior to applying for ICHIA coverage with no lapse in coverage exceeding 63 day. Your most recent coverage must have been under a group health plan and you are not still eligible for group health insurance or COBRA coverage. You must not have other health insurance available to you and your previous cover must not have been terminated for non-payment of premium or fraud.
- If offered COBRA benefits, you must have exhausted your COBRA benefits
- You have received a notice of rejection from another health insurance company that offers standard issue health insurance in the State of Indiana
- You are covered under an individual health insurance policy, but not eligible for any coverage that equals or exceeds the minimum requirements for accident and sickness policies in Indiana, or received notice of a premium that exceeds the rate charged for coverage under an ICHIA plan
Enrollment Periods
You may first apply for Medicare within 60 days prior to submitting an application to ICHIA and provide a fully executable Medicaid Application verification form. Cover will be effective the later of the date your application is approved; the day after your previous medical insurance terminates; or a future date of your choosing as long as it is within 60 days of submitting your application.
Premium Payments
Premiums are based on your health plan selection, your gender, your age and the geographical area in Indiana in which you reside.
Premium Calculations
Premiums for the ICHIA plan is capped at 150% of standard risk rates available for plans of similar benefit levels.
Pre-Existing Condition Waiting Periods
ICHIA plans exclude paying benefits on pre-existing conditions for three months following the effective date of coverage. The pre-existing exclusionary period will be waived if you lost your previous health insurance within 6 months of the date you apply for ICHIA coverage. Proof of prior coverage must be provided at time of application.
Indiana Comprehensive Health Insurance Association Contact Information
ACS Healthcare Solutions
4550 Victory Lane
Indianapolis, IN 46203
Phone: 800-552-7921
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