Iowa Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Iowa Comprehensive Health Association / HIPIOWA
Insurance Regulation Establishing Risk Pool
Iowa State Legislation
Chapter 514E Iowa Comprehensive
Funding
HIPIOWA is funded partially by the premiums collected by plan members. Deficits are subsidized by assessments paid by health insurance companies operating in the State of Iowa.
Plans Offered
HIPIOWA offers a Plan A which is a Medicare preferred provider plan for persons under 65 that are enrolled in Medicare. Plan A is secondary to Medicare. Plans B, C and D are PPO plans and are offered to members that are not eligible for Medicare.
Plan Benefits
The Medicare Carve-out Plan A has a $1,000 annual deductible in-network and $2,000 out-of-network. The maximum annual out-of-pocket limit is $2,500 in-network and $5,000 for out-of-network treatment. Plan B has a $1,000 annual deductible in-network and $2,000 out-of-network. The maximum annual out-of-pocket limit is $2,500 in-network and $5,000 for out-of-network treatment. Plan C has a $1,500 annual deductible in-network and $3,000 out-of-network. The maximum annual out-of-pocket limit is $3,000 in-network and $6,000 for out-of-network treatment. Plan D has a $2,500 annual deductible in-network and $5,000 out-of-network. The maximum annual out-of-pocket limit is $5,000 in-network and $10,000 for out-of-network treatment. All plans have a 20% coinsurance for in-network services and 40% for out-of-network. If you choose to go out of network your benefit amount is reduced to 60% from 80%. All HIPIOWA plans allow you to carryover the last 90 days of deductible expenses from the previous calendar year. Your choice of providers is available through the Midlands Choice Provider network.
Maximum Benefit Limits
Lifetime maximum dollar benefit under the HIPIOWA plans is $3,000,000.
Eligibility
- You must be a resident of Iowa for at least 60 days and also meet the guidelines outlined in one of the following eligibility categories
- Medically Eligible Category: a) you must have received a notice of declination of health insurance coverage within the last 9 months, or b) you received a notice of a benefit reduction or limitation for health insurance which substantially reduced your plan benefits as compared to the benefits that are available to others, or c) you were approved for a health insurance policy, but at a premium rate that is higher than the premium of a similar plan available under HIPIOWA, and d) your previous health insurance was involuntarily terminated
- Medical Condition Category: You have one of the medical conditions listed under the HIPIOWA eligibility guidelines under the presumptive list for this eligibility category (refer to plan brochure)
- Federal Eligibility Category: a) you have had 18 months of continuous health insurance coverage without a gap of more than 63 days, and b) your most recent health insurance coverage must be through a group health plan, a government health plan or church health plan, and c) you are not eligible for other group health insurance, and d) you are not eligible for Medicare or Medicaid, and e) you have exhausted your COBRA option if it was available to you
- Basic and Standard Eligibility Category: You are eligible if you are a current Basic and Standard Policy Holder
Enrollment Periods
Once you have met the various eligibility guidelines you can start the application process. Complete and approved applications received on the 20th of the month will be given an effective date on the first of the month following the 20th. If you are applying for coverage under the Federally Eligible category, your application must be submitted within 63 days of the termination date of your previous group health insurance policy.
Premium Payments
Premiums are determined according to the HIPIOWA plan you select. Your age, gender and whether you use tobacco determine the amount.
Premium Calculations
The rates for a given classification shall not be more than one hundred fifty percent of the average premium or payment rate for that classification charged by the five carriers with the largest health insurance premium or payment volume in the state during the preceding calendar year. In determining the average rate of the five largest carriers, the rates or payments charged by the carriers shall be actuarially adjusted to determine the rate or payment that would have been charged for benefits similar to those issued by the association.
Pre-Existing Condition Waiting Periods
There is a 6 month exclusionary period on receiving benefits for pre-existing medical conditions. Refer to plan brochure for exceptions.
Iowa Comprehensive Health Association Contact Information
Iowa Comprehensive Health Association
HIPIOWA
P.O. Box 1090
Great Bend, KS 67530
Phone: (877) 793-6880
Fax: (620) 792-0535
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