Options after your health insurance is terminated
Other individual plans
Persons whose coverage is involuntarily terminated may apply for coverage with other insurers that sell individual policies, but they have the right to reject applicants because of, for example, previous health history. Generally speaking, few restrictions exist on how much an insurer may charge in premiums for individual coverage.
Neither Missouri nor federal law guarantees individual policyholders the right to purchase individual commercial health insurance coverage elsewhere when their insurer leaves the market.
Missouri Health Insurance Pool
Those who are involuntarily terminated, however, do have the right to buy coverage from the state-established, but privately operated Missouri Health Insurance Pool. This coverage costs twice the state average premium for a person of similar age and gender.
The pool usually requires persons to wait one year for coverage of pre-existing conditions, but if the applicant has immediate prior coverage, he or she gets credit for that time. For example, if a person had coverage for four months before the previous plan terminated, then the pre-existing condition wait would only last eight months; if the person had been covered for a year or more by a commercial plan, no wait would occur. To get credit for previous coverage, you must apply to the pool within 60 days of the termination.
The MHIP offers individual health coverage for persons who have been turned down in the private market, involuntarily terminated from their health care coverage, being charged more than 300 percent of standard premiums for health insurance, qualify for the federal Health Coverage Tax Credit or are currently enrolled as HIPAA eligibles in plans offered by the state’s individual insurers and HMOs.
What are the new rates for the Missouri Health Insurance Pool?
The premium rates for the MHIP are established by the MHIP Board of Directors. The rates are 125% - 150% of the standard market rates. For 2008, the rates will be 150% of standard. A new evaluation is being completed by MHIP to establish the standard rate.
I am HCTC eligible. Will the MHIP cover me?
Yes. The MHIP will set up a secondary pool to cover those who are Health Coverage Tax Credit qualified. The HCTC procedures need to be coordinated with the federal government. There has to be a system by which the federal government transfers the premium subsidy funds directly to MHIP. The system is not in place yet, but MHIP is working on it.
How do I sign up for the Missouri Health Insurance Pool?
Missouri Health Insurance Pool
Penntower Building
3100 Broadway, Suite 210
Kansas City, Missouri 64111-2553
1-800-821-2231
A federally guaranteed alternative
Federal law also requires that employer-sponsored group health plans--both commercial and self-insured--hold special enrollments for employees and eligible dependents who lose their coverage elsewhere if they had declined earlier because they had other coverage. Prior coverage is counted against any pre-existing condition exclusion period. Persons must apply within 30 days after losing other coverage.