Health insurance pools provide insurance for individuals ineligible through other providers.
Individuals with serious health conditions are considered high risk to most health insurance companies. Pre-existing conditions such as diabetes, cancer and HIV can cause individuals suffering from the conditions to be denied individual health insurance. Health insurance pools were designed to provide insurance coverage for individuals who do not have access to health insurance from other sources. The State of Missouri has a high risk health insurance pool that provides protection to Missouri residents who have been turned down for health insurance from other carriers.
Eligibility
Only Missouri residents are eligible to participate in the Missouri Health Insurance Pool (MHIP). Residents must be able to provide proof that they have been turned down for similar insurance from at least two insurance companies. Individuals whose insurance has been involuntarily terminated for reasons other than non-payment of premium are eligible to apply. Also, participants whose health insurance premiums have exceeded rates above the MHIP rate standards are eligible to apply.
State Benefits
The Missouri Health Insurance Pool provides manged care benefits such as inpatient and outpatient care, home health care, maternity and residential treatment facilities coverage. The MHIP also provides medical benefits to pay for medically necessary supplies and services. Medical service benefits include preventative care such as cancer screenings, mammogram exams and immunizations. Other medical benefits include emergency room and chiropractic care as well as treatments provided by a primary care physician.
Federal Benefits
The federal government has enacted an insurance plan for individuals who are considered high risk. The federal Pre-existing Conditions Insurance Plan provides major medical coverage for participants who cannot obtain insurance because of a serious health condition. The state of Missouri has developed a medical plan in conjunction with the federal PCIP plan to provide coverage for participants through a preferred provider network. After a $1,000 annual deductible is met, the plan will pay 80 percent from care received from in-network providers. The plan will pay 50 percent for care received out of the network.
Providers
The MHIP is a Preferred Provider Network (PPO) which means participants receive a higher level of service and lower out of pocket costs by choosing doctors and hospitals within the provider network. There are over 16,000 physicians and 130 hospitals that participate in the PPO. MHIP providers participate in the Blue Cross Blue Shield PPO network.
Costs
Missouri high risk health insurance rates vary depending on the age, gender and plan selection of the individual participant. By law, the state of Missouri cannot set premiums that exceed 200 percent of the average rate standards for comparable coverage. An example of rates for the MHIP $1,000 deductible plan for females between the ages of 40 to 44 is $784 per month. The rates for males in the same category are $543 per month. As age increases, the monthly premium increases. Participants who choose a plan with a higher deductible can save on their monthly premiums.
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