Utah Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Utah Comprehensive Health Insurance Pool / HIPUTAH

Insurance Regulation Establishing Risk Pool
Utah State Legislature
1990

Funding

HIPUtah is funded through premiums collected from persons enrolled in a health plan under the risk pool program. Additional funds to offset deficits come from especially dedicated state funds called the Utah Comprehensive Health Insurance Pool Enterprise Fund.

Plans Offered

There is one medical insurance plan offered through the HIP Utah program. The plan is a PPO plan with a variable of two different deductibles.

Plan Benefits

The HIP Utah PPO plan offers one plan with deductibles of either $500 or $1,000. This deductible applies only to In-Network covered medical services. For most in-patient covered medical expenses, the HIP Utah member is required to pay a 20% coinsurance. For most out-patient covered medical services, the HIP Utah member is required to pay a 20% coinsurance. The maximum out-of-pocket limit is $1,500, including deductible, on the $500 deductible plan and $2,000, including deductible, on the $1,000 deductible plan.

Maximum Benefit Limits

The maximum benefits provided by HIP Utah are $200,000 each calendar year with a maximum lifetime benefit of $1,000,000.

Eligibility

• Your must be a resident of Utah for the 12 months preceding your HIPUtah application submittal date
• You must meet the underwriting criteria established by the State of Utah
• You are not eligible for Medicaid or Medicare unless you have a spend-down that exceeds the premium for a Hip Policy
• Your previous health insurance coverage must have been involuntarily terminated and was not cancelled for non-payment of premium
• You have not exhausted the maximum lifetime benefits under the risk pool
• You must not be an inmate of a public institution
• You must not be eligible for other public health insurance programs
• You must not be eligible for group health insurance
• You must not have over coverage that is substantially equivalent to HIPUtah coverage
• You do not need to be a 12 month resident of Utah if you had coverage under another state risk pool plan and recently moved to Utah and apply for coverage within 63 days
• You do not need to be a 12 month resident of Utah if you are a recent resident of Utah and are HIPAA eligible

Enrollment Periods

Once you have applied and been accepted for coverage under HIPUtah, you must meet with a HIPUtah representative within 90 days to complete the final interview before your coverage becomes effective. This final approval step is not required if you are HIPAA eligible.

Premium Payments

Premiums for the HIP Utah plan are based on your plan selection and age.

Premium Calculations

Contact HIPUtah on information on how the premium rates are calculated.

Pre-Existing Condition Waiting Periods

There may be a 6-month pre-existing medical condition waiting period following the effective date if in some cases. The waiting period of a person with a pre-existing condition is waived if the applicant is eligible for coverage under federal HIPAA regulations or the waiting period was satisfied under a similar plan from another state and the other state's benefit limitation was not reached.

Utah Comprehensive Health Insurance Pool Contact Information

HIP Utah
C/O Regence Blue Cross/Blue Shield of Utah
2890 East Cottonwood Parkway
P.O. Box 27797
Salt Lake City, UT 84127-0797
Phone: 1-800-462-2767

HIPUtah Website

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