Nebraska Health Insurance Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Comprehensive Health Insurance Pool / CHIP
Insurance Regulation Establishing Risk Pool
Nebraska Legislature
Neb.Rev.Stat. 44-4201 through 44-4235
Comprehensive Health Insurance Pool (CHIP)
The Nebraska Comprehensive Health Insurance Pool (NECHIP), created by the Nebraska legislature in 1985, provides health insurance to Nebraska residents who are unable to obtain it at an affordable price or without restrictions because of a medical condition.
To be eligible, the individuals must have at least 18 months prior creditable coverage, most recently under a group health plan, governmental plan or church plan; should not be eligible for another group health plan, Medicare or Medicaid, or have other health insurance coverage; and continuation coverage under COBRA or a similar program, if offered, has been exhausted, or COBRA or similar insurance is provided at a higher rate than CHIP. HIPAA-eligible Nebraska residents and eligible individuals for the Health Coverage Tax Credit under the Trade Adjustment Assistance Reform Act of 2002 also qualify for the CHIP.
Funding
CHIP funds are gathered from premiums paid by plan members and legislation that requires the Department of Insurance to establish a special fund from the premium tax of all health and accident premiums
Plans Offered
There is one medical insurance plan offered through CHIP. The plan is a PPO plan with a variable of nine different deductible. CHIP also offers a Health Savings Account Plan.
Plan Benefits
The CHIP PPO Plan offers a range of In-Network deductibles from $500 to $10,000. Doctor office visits have a $10 co-pay and for most in-patient covered medical expenses, the CHIP member is required to pay a 20% coinsurance. For most out-patient services, the CHIP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit is $1,500 after deductible. Contact the Plan Administrator for more information on the Health Savings Account.
CHIP Plan Details
Maximum Benefit Limits
All CHIP PPO Plans have a lifetime maximum benefit of $1,000,000.
Eligibility
There are two different standards by which to determine if you are eligible to become a member of the CHIP Plan:
Standard Eligibility Requirements
- You have been a Nebraska resident for at least six months
- And, you have been rejected for health insurance coverage for medical reasons within the last six months from an insurer
- Or, you have been offered, within the last six months, health insurance coverage which includes a restrictive rider limiting coverage for a pre-existing medical condition
- Or, you have been refused comparable health insurance coverage or have been offered a comparable coverage at a higher premium with the last six months
- Or, you have one of the specified conditions as listed in the CHIP brochure
HIPPA Eligibility Requirements
- You have been a Nebraska resident for any length of time
- And, you have been covered for 18 months by prior creditable coverage under a group employer, governmental or church plan
- And, you are not eligible for another group health plan, Medicare due to age, or Medicaid, or have other health insurance coverage
- And, your most recent coverage was not terminated because of nonpayment of premium or fraud
- And, if offered COBRA coverage and exhausted it, the premium for the continuation coverage is higher than the CHIP premium
Enrollment Periods
CHIP coverage will be effective on the first day of the month following approval of your application.
Premium Calculations
Premium charges are based on 135% of average standard health insurance rates for similar type coverage from private insurers in Nebraska. Premium charges for children are set at 50% of the standard rate.
Pre-Existing Condition Waiting Periods
CHIP has a 6 month exclusionary period on paying benefits towards pre-existing medical conditions. There are several circumstances in which this waiting period may be waived. Your pre-existing condition waiting period waiver will be determined at time of application review.
Nebraska Comprehensive Health Association Contact Information
CHIP Customer Service Center
C/O Blue Cross and Blue Shield of Nebraska
P.O. Box 3248
Omaha, Nebraska 68180-001
Phone: 402-343-3574
Outside of Omaha: 877-348-4304
Nebraska CHIP Website
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