Maryland Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Maryland Health Insurance Plan / MHIP
Insurance Regulation Establishing Risk Pool
Maryland General Assembly
Health Insurance Safety Act of 2002
Maryland Health Insurance Plan (MHIP)
The Maryland General Assembly established the Maryland Health Insurance Plan under the Health Insurance Safety Net Act of 2002 to offer health insurance program to Maryland residents who have been unable to obtain health insurance from private insurers due to pre-existing health conditions. To be eligible for the risk pool coverage, another health insurance company must have declines coverage to you for medical reasons within the past six months; you have lost your employer-sponsored group plan or exhausted your COBRA benefits and you are not eligible for Medicare.
Funding
MHIP is funded partially by the premiums collected by plan members and tax assessments on hospitals operating in the State of Maryland.
Plans Offered
MHIP enrollees have 5 different health plans to select from: the HMO Plan; the PPO Plan with $500 medical deductible; the PPO Plan with $1,000 medical deductible and the High Deductible Health Plan with $2,600 combined medical and pharmacy deductible.
If you have a limited income, you may be eligible for MHIP+.
Plan Benefits
The HMO Plan has no annual deductible, set low dollar co-payments for many covered medical expenses and no annual out-of-pocket maximum. The $500 PPO Plan has an annual deductible of $500, a 20% coinsurance for most in-network covered services and an annual-out-pocket maximum of $3,000. The $1,000 PPO Plan has an annual deductible of $1,000, a 20% coinsurance for most in-network covered services and an annual-out-pocket maximum of $3,500. The High Deductible Health Plan has an annual deductible of $2,600. Once the annual deductible has been met, most covered medical expenses are covered in full for the remainder of the calendar year.
Maryland Health Insurance Plan Brochure
Maximum Benefit Limits
All plan options available through MHIP have a $2,000,000 lifetime maximum benefit.
Eligibility
- You must be a resident of Maryland and meet one of the following conditions
- You are not eligible for group health insurance, COBRA, Maryland Medical Assistance or Children's Health Plan, Medicare or any other government sponsored health plan
- You have exhausted your group health insurance or COBRA coverage, or have moved to Maryland and were covered under a high-risk pool health insurance plan in your previous state and you have 18 months of continuous coverage with a gap of no more than 63 days
- You have been offered, or are currently insured, on an individual health insurance plan that provides restrictions on your coverage or exclude paying benefits on a specific medical condition or has a premium that exceeds the premium for MHIP on a similar plan type
- You have been denied standard issue health insurance coverage due to medical reasons within the past six months
- Or, you are receiving a federal Trade Readjustment Allowance or benefits under the Trade Adjustment Assistance Program or Pension Benefit Guaranty Corporation
- You have one of the medical conditions listed on the MHIP eligibility guidelines
Enrollment Periods
Applications received on or before the 15th day of the month will have their coverage made effective on the 1st day of the following month. Dependents may be added to your existing MHIP coverage under certain qualifying events or during the annual open enrollment period. Current plan members may also change their plan choice during open enrollment period.
Premium Payments
Premiums for Maryland Health Insurance Plan are based on your plan selection and your age.
Premium Calculations
MHIP premiums are calculated by review the standard risk rates of similar plans available to Maryland residents that qualify for standard issue health issue. The MHIP plan rates must be no less than 100% of the standard risk rate and no higher than 150% of the standard risk rate.
Pre-Existing Condition Waiting Periods
There will be no exclusion of benefits for pre-existing medical conditions if you can prove creditable coverage, with your most recent coverage under a group health plan. The length of time that you were covered under your previous health plan will be applied to your pre-existing condition waiting period. If you were previously uninsured for more than 63 days, then you may have to fulfill the waiting period. Pregnancy is not subject to the pre-existing condition waiting period.
Maryland Health Insurance Plan Contact Information
Individual Enrollment and Billing
10455 Mill Run Circle
Mail Stop RR-291
Owings Mills, MD 21117-9185.
Phone: 888-444-9016
MHIP Website
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