Alabama maintains a high-risk pool, called the Alabama Health Insurance Plan (AHIP).  AHIP provides health insurance coverage only to HIPAA eligible persons.

When can I get coverage from the AHIP?

•    If you are HIPAA eligible, you can buy health insurance from AHIP.  If you are not HIPAA eligible, you are not eligible for the AHIP.

To be HIPAA eligible, you must meet certain criteria

No matter where you live, if you are HIPAA eligible you are guaranteed the right to buy an individual health plan with no pre-existing condition exclusion periods. In Alabama, you are guaranteed the right to buy coverage only from Blue Cross Blue Shield of Alabama. To be HIPAA eligible, you must meet all of the following:

• You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
• You also must have used up any COBRA continuation coverage for which you were eligible.
• You must not be eligible for Medicare, Medicaid or a group health plan.
• You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be HIPAA eligible.)
• You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

HIPAA eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.

• AHIP offers both an individual person policy and a policy for individuals with dependent children.  However, if you have a spouse that is also HIPAA eligible, they cannot be included on your policy and will have to purchase their own AHIP policy.

What will health insurance from AHIP COVER?

• As of January 2008, AHIP offers a choice of two plan options. If eligible for AHIP, you can buy either the Managed Care Plan, administered by United Health Care or the Traditional Indemnity Plan, administered by BlueCross BlueShield of Alabama.

  Although both plans cover similar benefits and services, your choice of providers and the amount of cost sharing you will face will vary depending on which plan you buy.
  Generally, the Managed Health Plan limits your out-of-pocket costs for covered care but requires you to get services only from a list of in-network doctors, hospitals, and other providers. Under the Traditional Indemnity Plan, you will be able to get care from a broader list of providers, including out of network providers, but the plan requires higher cost sharing on your part.

• Benefits may vary depending on the type of plan you buy. Benefits are generally similar for both the Managed Care Plan and Traditional Indemnity Plan though there are some important differences.  For example, under the Managed Care Plan, the prescription drug benefit is capped at $10,000, whereas there is no prescription drug benefit limit under the Traditional Indemnity Plan.

  Also, lifetime limits vary depending on the plan you choose. The Managed Care Plan has no lifetime limit, while the Traditional Indemnity Plan has a lifetime maximum of $1 million.

  Cost-sharing varies depending on the type of plan you buy. Generally, cost sharing under the Managed Care Plan is more predictable than under the Traditional Indemnity Plan.

  Under the Managed Care Plan, enrollees do not have to meet a deductible before the insurer starts paying from care. In addition, they will not be required to pay co-insurance for services.  However, for most services, you will have to pay a significant co-pay, ranging from $50 to $500.

  Under the Traditional Indemnity Plan, for most services, enrollees must meet an annual deductible of $1,000 or $2,500 before the insurer will pay. For some services, such as inpatient hospital care, separate deductible applies.  In addition, for most services, enrollees must pay co-insurance (called a co-pay under the plan), which is generally 20% of the covered expense but may be higher depending on the benefit.  For example, the co-pay for outpatient mental health services is 50% of the covered expense.  Finally, co-pays can be much higher for services provided by out-of-network providers.

• For a full description of covered benefits, contact AHIP directly at (334)-352-8924 or visit them on the web for a summary description of each plan at www.alseib.org/healthinsurance/ahip.

What about coverage for my pre-existing condition?

• If you are eligible for AHIP, you will not face a pre-existing exclusion period.

What can I be charged for health insurance from AHIP?

• Premiums vary depending on the coverage option you choose, your age and gender, and whether you smoke. For example, as of January 1, 2008, for the indemnity plan with a $1,000 deductible, the monthly premium is $273 for a 25-year-old male non-smoker and $908 per month for a 64-year-old non-smoker. Generally, premiums for the higher deductible indemnity plan are less expensive than the managed care plan, but enrollees face higher cost sharing. Premiums increase each year with your age and will adjust depending on your smoking status.

How long does health insurance from AHIP last?

• AHIP policies are renewable as long as you pay your premiums, continue to reside in Alabama, and meet other eligibility requirements.