North Dakota Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Comprehensive Health Association Of North Dakota / CHAND
Insurance Regulation Establishing Risk Pool
North Dakota Legislature - 1981
The 1997, the Legislature modified CHAND to implement the guidelines set forth under the Health Insurance Portability and Accessibility Act (HIPAA) of 1996.
Comprehensive Health Association Of North Dakota (CHAND)
The Comprehensive Health Association of North Dakota, created by the state legislature in 1981, offers health insurance to North Dakota residents who either are unable to find adequate health insurance coverage in the private market due to medical conditions or who have lost their employer-sponsored group health insurance.
Funding
CHAND is funded by the premiums collected from plan members and assessments to health insurance companies who do a minimum of $100,000 of premium volume annually in North Dakota.
Plans Offered
There are two medical insurance plans available through CHAND. Option 1 and Option 2, both plans are PPO plans.
Plan Benefits
The Option 1 plan has an annual deductible of $1,000.00. For most in-patient covered medical services, there is a 20% coinsurance. For most out-patient services, the coinsurance is 20%. The maximum out-of-pocket limit is $3,000.00 which includes the annual deductible. The Option 2 plan has an annual deductible of $500.00. For most in-patient covered medical services, there is a 20% coinsurance. For most out-patient services, the coinsurance is 20%. The maximum out-of-pocket limit is $3,000.00 which includes the annual deductible. Chiropractic options may be added to either of these plans at an additional cost.
Maximum Benefit Limits
For both, Option 1 and Option 2 plans, CHAND coverage offers a lifetime maximum of $1,000,000.00.
Eligibility
There are three eligibility Categories in which you can qualify for coverage through CHAND
Standard Eligibility
- You have physically resided in the state of North Dakota for at least 183 days
- You have written evidence from at least one carrier that within 180 days, you have been; a) denied health care insurance coverage for health reasons, or b) offered coverage which substantially restricts benefits for specific conditions, or c) offered an insurance rate exceeding the CHAND rate; or d) you have written evidence from a medical professional of the existence of a qualifying condition
- You are not eligible for health benefits under the state of North Dakota's medical assistance program
- You are not an inmate or a resident of a public institution
- Your health insurance premiums are not paid for or reimbursed under any government sponsored program, government agency, health care provider, nonprofit charitable organization or your employer
- You have not been insured through CHAND during the last 12 months
HIPAA Eligibility
- You currently reside in the state of North Dakota
- You have had 18 months of previous health insurance coverage, the most recently under a group health benefit plan, government plan, church plan, or health insurance coverage offered in connection with any of these types of plans
- You have applied for CHAND coverage within 63 days of the termination date of your prior qualifying health insurance coverage
- You are not eligible for coverage under a group health benefit plan, Medicare or Medicaid and do not have other active health insurance
- Your most recent coverage was not terminated for nonpayment of premiums or fraud
- You have declined continuation coverage from your group health plan or you elected to enroll in continuation coverage and have exhausted the coverage
- You are not eligible for health coverage under the medical assistance program through the State of North Dakota
- Your health insurance premiums are not paid for or reimbursed under any government-sponsored program, by any government agency or health care provider
TAARA Eligibility
- You currently reside in the state of North Dakota
- You are eligible for federal trade assistance and health insurance tax credit (TAA) or for PBGC as provided by the Federal Trade Adjustment Assistance Reform Act of 2002
- You have had a minimum of three months of previous health insurance coverage
- You have applied for CHAND coverage within 63 days of the termination date of your prior qualifying health insurance coverage
- You are not an inmate or a resident of a public institution
- You have not been insured through CHAND during the last 12 months
- You are not eligible for health coverage under the medical assistance program through the State of North Dakota
Enrollment Periods
Coverage begins on the first day of the following month if your applicant is received prior to the cut-off date for each month.
Premium Payments
Premiums for CHAND are based on your plan selection and age
Premium Calculations
Premiums are based on the standard risk rate for similar type coverage available to North Dakota residents. The CHAND rates are capped at 135 percent of the average amount charged for standard coverage in the state.
Pre-Existing Condition Waiting Periods
There is a 180 day waiting period for preexisting conditions, which is waived if the applicant had continuous coverage under another health policy immediately preceding. Waiver of pre-existing exclusionary periods is enrollment is based on HIPAA eligibility requirements.
Comprehensive Health Association Of North Dakota Contact Information
Comprehensive Health Association of North Dakota
4510 13th Avenue S.
Fargo, North Dakota 58121-0001
Phone: 701-277-2271
CHAND Website
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