Kentucky Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Kentucky Access
Insurance Regulation Establishing Risk Pool
Kentucky Legislature
Kentucky Revised Statute Chapter 304.17B
Funding
Kentucky Access is funded partially by the premiums collected by plan members, a state tobacco tax and assessments charged to the health insurance companies operating in the State of Kentucky.
Plans Offered
There are three medical insurance plans available through the Kentucky Access program. The Traditional Access plan is a fee-for-service plan. The other two plans, the Premier Access and the Preferred Access, are both PPO plans.
Plan Benefits
The Traditional Access fee-for-service plan has an annual deductible of $400. For most in-patient covered medical expenses, there is a 15% coinsurance. For most out-patient services, the coinsurance is 20%. The maximum out-of-pocket limit is $1,500 after deductible.
The Premier Access PPO plan has three annual deductible: $700, $1,500 and $2,250. For most in-patient covered medical expenses, there is a 35% coinsurance. For most out-patient services, the coinsurance is 40%. The maximum out-of-pocket limit is $2,500 for the $700 deductible plan, $3,000 for the $1,500 deductible plan and $4,500 for the $2,250 deductible plan.
The Preferred Access PPO plan has two annual deductible: $750 and $1,500. For most covered medical expenses there is a 40% coinsurance. The maximum out-of-pocket limit is $3,000 for the $750 deductible plan and $5,000 for the $1,500 deductible plan.
Maximum Benefit Limits
The Traditional Access plan has unlimited lifetime maximum benefits. For the Premier Access PPO plan, there are unlimited lifetime maximum benefits on the $400 deductible plan and a $2,000,000 maximum for all other deductible options. The Preferred Access PPO plan has a $2,000,000 lifetime maximum for all deductible options.
Eligibility
- You must be a resident of Kentucky for at least 12 months and also meet the guidelines outlined in one of the following eligibility categories:
- Federally Eligible Category is for those who qualify as "eligible individuals" under federal HIPAA regulations. To be HIPAA eligible, your most recent health insurance coverage must have been through a group health, governmental, church, COBRA or state continuation medical plan
- Insurance Rejection Category is for those individuals that have been declined individual health insurance through an insurance company that offers health plans similar to those offered through Kentucky Access
- High Premium Rate Category is for those that were offered individual health insurance, but at a rate higher than a similar health plan offered through Kentucky Access
- High Cost Condition Category is for those who have one of the medical conditions that are listed in the Kentucky Access eligibility guidelines
- GAP Eligible Category is for participants in the state Guaranteed Acceptance Program
- Spouse or Child Category is for eligible dependents of a person that is covered under the Kentucky Access program
Enrollment Periods
Applications are accepted at anytime but Kentucky Access suggests that applications are submitted within 63 days of losing your previous health insurance coverage so you will not have a lapse in coverage. Coverage is effective on the 1st of the month following that date your application is received by Kentucky Access. You may choose a later effective date within 3 months of the date you submit your application.
Premium Payments
Premiums for Kentucky access plans are based on your plan selection, your gender and your age.
Premium Calculations
KHIA premiums are capped at 175% of the standard risk rate for similar type health insurance coverage available to Kentucky residents that qualify for standard issue individual health insurance.
Pre-Existing Condition Waiting Periods
Kentucky Access plans have a 12 month waiting period for benefits on pre-existing conditions, unless you qualify for a waiver based on the length of time your previous health insurance was in effect and when it expired. Other restrictions may apply to the waiver.
Kentucky Access Contact Information
Kentucky Access
P.O. Box 33707
Indianapolis, IN 46203-0707
Phone: 866-405-6145
Kentucky Access Website
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