Missouri Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Missouri Health Insurance Pool / MHIP
Insurance Regulation Establishing Risk Pool
Missouri 92nd General Assembly
House Bill No. 437
Missouri Health Insurance Pool (MHIP)
The MHIP, established through a legislation enacted by the Missouri General Assembly in 1991, provides health coverage to medically uninsurable Missouri residents who are unable to obtain private health insurance. To be eligible for this program, you must have been involuntarily terminated from your healthcare coverage or are being charged more than 150% of standard premiums for the coverage.
Funding
MHIP receives funding from different sources. Premiums collected by insured members and assessments paid by heath insurance companies and HMO's operating in the State of Missouri are used to pay operating costs and make medical claim payments.
Plans Offered
There are four medical insurance plans available through the MHIP program. All four plans are PPO plans offering a range of deductibles including $500, $1,000, $2,500 and $5,000
Plan Benefits
All medical plans offered through MHIP require that you pay a coinsurance of 20% when using providers that participate in the PPO network. Medical treatments received out-of-network requires a 50% coinsurance. Plan 1 has an annual deductible of $500.00 and the maximum out-of-pocket limit is $2,500.00 after deductible. Plan 2 has an annual deductible of $1,000.00 and the maximum out-of pocket limit is $5,000.00 after deductible. Plan 3 has an annual deductible of $2,500.00 and the maximum out-of pocket limit is $5,000.00 after deductible. Plan 4 has an annual deductible of $5,000.00 and the maximum out-of pocket limit is $5,000.00 after deductible.
Maximum Benefit Limits
Each of the MHIP PPO health plans offers a lifetime maximum benefit of $1,000,000.00.
Eligibility
- You must be a Missouri resident
- You have been turned down for two individual health insurance except at a rate exceeding the plan rate for substantially similar health insurance
- You are a federally defined eligible individual who has not experienced a significant break in coverage; or a trade act eligible individual; or any resident dependent of a person who is eligible for plan coverage; or any person, regardless of age, that can be claimed as a dependent of a trade act eligible individual on such trade act eligible individual's tax filing
- Your health insurance coverage is involuntarily terminated for any reason other than nonpayment of premium or fraud, and you are not otherwise ineligible for this program
- Your premiums for health insurance coverage have increased above the 150% of standard and are otherwise eligible for this program
- You are currently insured who would have qualified as a federally defined eligible individual or a trade act eligible individual between the effective date of the federal Health Insurance Portability and Accountability Act OF 1996.
Enrollment Periods
You may apply for MHIP at anytime. Your effective date will be either the first day of the month following your approval date or you have the option of making it effective the date immediately following the termination of your previous health coverage.
Premium Payments
The cost for MHIP coverage varies according to the benefit plan selected and the age and gender of the enrollee. Premiums can be billed and paid monthly or quarterly. Premiums can also be automatically deducted from the enrollee's bank account.
Premium Calculations
MHIP rates are determined by calculating the average individual standard rate charged by the five largest individual health insurers in Missouri. For comparable coverage, the initial rates for risk pool coverage will not be less than 125% of the standard risk rates and shall not exceed 200% of that same base rate.
Pre-Existing Condition Waiting Periods
MHIP excludes paying benefits on pre-existing conditions for the first six months of coverage. Under specific circumstances, this exclusionary period will be waived. You can contact an MHIP representative for details on the pre-existing medical condition exclusionary period and waiver.
Missouri Health Insurance Pool Contact Information
MHIP
Penntower Building
3100 Broadway, Suite 210
Kansas City, Missouri 64111-2553
Phone: 800-821-2231
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