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February 16, 2012

State by State Guide to Guaranteed Issue Health Insurance in 2012


By Mike Hill

Note: None of this should be taken as legal or tax advice.

Guaranteed issue individual health insurance exists in all 50 states. Last year, we posted a comprehensive guide to guaranteed issue health insurance. This year's guide includes state-specific updates and a brief overview of the types of guaranteed issue health insurance.


HIPAA Plans
 

Effective January 1st, 2006, federal law (HIPAA) requires all states to provide guaranteed individual health plans to residents who meet certain eligibility criteria. Individuals who meet this criteria are commonly referred to as "HIPAA-eligible" (or "federally HIPAA-eligible") individuals. If an individual meets the federal definition of "HIPAA-eligible", then the state must provide that individual with guaranteed issue individual health insurance. Typically, states provide these plans through a state risk pool. However, some states transfer this responsibility to private insurance companies.

Most states go far beyond this federal mandate and offer guaranteed issue individual health insurance plans to all of their uninsurable residents.

Federal Pre-Existing Condition Insurance Plan (PCIP)
Effective March 2010, United States citizens that have been uninsured for at least 6 months may purchase a guaranteed issue individual health insurance plan through the temporary federal risk pool (PCIP).

A state-by-state summary is provided below for your convenience.


State Does the State Go Beyond Federal Requirements? State Risk Pool (if applicable) Plan/Eligibility Notes
Alabama No AHIP AHIP offers two plans to eligible individuals: Traditional Indemnity Plan through Blue Cross Blue Shield and a Managed Care Plan through United HealthCare.
Alaska Yes ACHIA Six (6) PPO plan choices for eligible individuals. Available to individuals that have had a restrictive rider that substantially reduced coverage.
Arizona No N/A
 
Arkansas Yes CHIP Individuals eligible through rejection of individual plan due to pre-existing condition or quoted rates greater than 50% of those offered through comparable CHIP plan. Multiple deductible choices, including HSA-qualified plan.
California Yes MRMIP
California has more options available to residents than most other states. Click here for a comprehensive guide to HIPAA, Conversion, and MRMIP plans in California.
 
Colorado Yes CoverColorado Eight (8) plan options, including HSA-qualified plan. Also eligible for CoverColorado if individual plan quote is higher than the CoverColorado option at the same deductible.
Connecticut Yes HRACT Multiple individual, conversion, and portability plans available.
Delaware No N/A
 
District of Columbia No N/A  
Florida Yes N/A Eligible individuals are offered choice of two conversion policies that have limits placed on premiums. The federal fallback offers eligible individuals the choice of any carrier's two most popular plans with no rate restrictions.
Georgia No N/A
 
Hawaii No N/A  
Idaho Yes HRP Five (5) plan options offered through six (6) different insurance carriers.
Illinois Yes ICHIP Traditional PPO, Medicare, HIPAA, and HIPAA-HTC plans available, including HSA-qualified plan.
Indiana Yes ICHIA
 
Five (5) plan options. Pre-existing condition exclusion waiver option available.
Iowa Yes HIPIOWA Five (5) PPO plan options. Medical condition eligibility options.
Kansas Yes KHIA Four (4) PPO plan options. Medical condition eligibility options.
Kentucky Yes Kentucky Access Eligible through insurance rejection, higher quoted premium rate, high cost condition, GAP eligible, spouse or child of a Kentucky Access enrolee, or a child unable to obtain individual coverage. Premier Access, Premier Access - Child Only, Preferred Access, and Traditional Access PPO plans available with multiple deductible choices.
Louisiana Yes LHP Four (4) plan options. Pre-existing condition waiting period of 6-months applies to high risk pool plans. No pre-existing condition waiting period for HIPAA plans.
Maine Yes N/A All insurance carriers must provide guaranteed issue health insurance to applicants, but may vary premiums based on age, geography, and tobacco use. Plan premiums may not be increased based on pre-existing conditions, claims history, or any other health-related factor other than age.
Maryland Yes MHIP MHIP Standard, MHIP+, MHIP Federal, and MHIP Federal+ plans available with choice of deductible. Plus (+) plans available to eligible individuals with limited income.
Massachusetts Yes N/A All insurers carriers must provide guaranteed issue health insurance to applicants. Open enrollment periods apply.
Michigan Yes N/A Blue Cross/Blue Shield of Michigan provides guaranteed issue coverage to eligible individuals. HMOs are required to provide guaranteed issue coverage to a limited number of applicants for one (1) 30-day open enrollment period per year.
Minnesota Yes MCHA Six (6) plan options. Also eligible for MCHA by loss of group coverage, Health Coverage Tax Credit (HCTC) Program, health-related rejection from individual health insurance carrier, or have been treated for a presumptive condition up to 3 years prior to application submission.
Mississippi Yes MCHIRPA Five (5) plan options. May not change from higher-deductible policy to lower-deductible policy.
Missouri Yes MHIP Five (5) risk pool plan options. Also eligible for MHIP if individual health insurance premiums are greater than 300% of standard individual premiums.
Montana Yes MCHA Also eligible for MCHA if premium rate is greater than 150% of average premium rate used to calculate MCHA premium rates. Eligible if applicant possesses a qualifying health condition
Nebraska Yes NECHIP Also eligible for NECHIP if applicant has one of the specified medical conditions listed or offered individual quote higher than NECHIP. Multiple deductibles available.
Nevada No N/A All insurance carriers must offer two guaranteed issue plans with limits on price
New Hampshire Yes NHHP Seven (7) plan options. Also eligible for NHHP through pre-qualifying medical condition or if individual quote is higher than NHHP.
New Jersey Yes N/A All insurers must provide products on a guaranteed-issue basis.
New Mexico Yes NMMIP Six (6) plan options. Also eligible for NMMIP through qualifying medical condition
New York Yes N/A All Insurers must Guaranteed Issue all products
North Carolina Yes Inclusive Health Four (4) plan options. Automatic enrollment available through presumptive medical condition. Also eligible if individual quote is higher than Inclusive Health
North Dakota Yes CHAND Four (4) major medical plan options and two (2) Medicare supplement plans.
Ohio Yes N/A All insurance carriers must offer guaranteed issue coverage, with a cap placed on participation. Two guaranteed issue products must be made available by the carriers
Oklahoma Yes OHRP Two (2) plan options: Original and Alternate with multiple deductible options. Also eligible for OHRP through medical condition, premium rate increase greater than OHRP rate, or involuntary termination of an individual health insurance plan
Oregon Yes OMIP Four (4) plan options. Also eligible for OMIP through qualifying medical condition
Pennsylvania No N/A Blue plans must provide guaranteed issue plans
Rhode Island Yes N/A Individual market insurers must guarantee issue of all products with 12 months of creditable coverage, provided that the applicant is not eligible for alternative group coverage, Medicare or any other state insurance plan
South Carolina Yes SCHIP Seven (7) plan options. Administered by Blue Cross Blue Shield of South Carolina
South Dakota Yes SDRP Seven (7) plan/deductible options. For unisurable child and adults who loss coverage or reached their lifetime maximum benefits (LMB)
Tennessee Yes AccessTN Three (3) plan options with varying deductibles. Also eligible if applicant has one of the specified 50 medical conditions
Texas Yes TXHIP Five (5) plan/deductible options. Also eligible for TXHIP through qualifying medical conditions
Utah Yes HIPUtah Four (4) plan/deductible options. Administered by Select Health of Utah
Vermont Yes N/A All Insurers must Guaranteed Issue all products
Virginia No N/A  
Washington Yes WSHIP Four (4) ppo plans and one (1) standard plan with multiple deductible options.
West Virginia Yes AccessWV Four (4) plan options. Eligible for AccessWV through recognized chronic or severe medical condition
Wisconsin Yes HIRSP Five (5) plan options including HSA. Eligible for HIRSP through pre-existing exclusion criteria
Wyoming Yes WHIP
 
Three (3) plan options: Brown, Gold and Catastrophic. Eligible for WHIP through "presumptive" conditions

 
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