Kansas Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Kansas Health Insurance Association / KHIA
Insurance Regulation Establishing Risk Pool
Kansas Uninsurable Health Insurance Plan
Kansas Health Insurance Association (KHIA)
The Kansas Health Insurance Association (KHIA), created by the Kansas State Legislature, provides health insurance coverage to all residents of the state who are unable to obtain individual health insurance from private health insurers.
A Kansas resident would be eligible for this risk pool, provided he is not eligible for COBRA; or Medicaid/Medicare; his most recent coverage was not terminated due to nonpayment of premiums or fraud and he does not have other health insurance coverage. The KHIA program also 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
KHIA 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 Kansas.
Plans Offered
All KHIA plans are PPO plans through either First Health or Preferred Health Care, depending on your geographic location. There are four plans to choose from, out of which one is an HSA qualified plan.
Plan Benefits
All health plans available through KHIA have prescription drug benefits. Each plan has the same coinsurance level, which is 30% in-network and 50% out-of-network. Plan A has a $1,500 annual deductible. HSA compliant Plan B has a $2,500 annual deductible. Plan C has a $5,000 annual deductible. Plan D has a $10,000 annual deductible. Plans C and D continue to have a 10% coinsurance after the annual deductible and coinsurance maximum have been met. Plan B deductibles and co-insurance are subject to change according to the IRS code section 220 in relation to CPI.
Maximum Benefit Limits
All health plans of KHIA have a $2,000,000 lifetime maximum benefit.
Eligibility
- You must be a resident of Kansas and also meet the guidelines outlined in one of the following eligibility categories
- Medically Condition Eligibility Category: a) you must have received a notice of declination of health insurance coverage by two health insurance carriers, or b) you were accepted for health insurance, but with an exclusion of benefits for pre-existing medical conditions, 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 KHIA, and d) your previous health insurance was involuntarily terminated for a reason other than non-payment of premium, and e) you are not eligible for group health insurance, Medicare Part A or Part B, and do not have other health insurance in effect.
- 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
Enrollment Periods
Applications are accepted at anytime. Upon approval, your coverage will begin on the first day of the month following your approval if it complete prior to the cut-off date. 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 for KHIA plans are based on your plan selection, gender, age and whether or not you use tobacco.
Premium Calculations
KHIA premiums are capped at 125% of the standard risk rate for similar type health insurance coverage available to Kansas residents that qualify for standard issue individual health insurance.
Pre-Existing Condition Waiting Periods
There is a 90 days (3 months) exclusionary period on receiving benefits for pre-existing medical conditions if there is a lapse in coverage of more than 31 days prior to their enrollment in KHIA.
Kansas Uninsurable Health Insurance Plan Contact Information
Kansas Health Insurance Association
KHIA
P.O. Box 1090
Great Bend, KS 67530
Phone: (800) 362-9290
Fax: (620) 792-0535
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