Alaska has a high risk pool program, called the Alaska Comprehensive Health Insurance Association (ACHIA), that offers insurance for people with health conditions who are unable to buy private health insurance coverage and for people who are HIPAA eligible.

When can I get a policy from ACHIA?

• There are several ways to qualify for ACHIA coverage. If you are HIPAA eligible, you will be able to purchase ACHIA coverage.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible in Alaska, you are guaranteed the right to buy an individual health plan from ACHIA and are exempted from pre-existing condition exclusion periods.  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 or state 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 federally eligible.)
• In Alaska, you must apply within 90 days to receive ACHIA coverage without a pre-existing condition exclusion period. (In most other states, however, 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 ACHIA or 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.

• If you are eligible for the federal health coverage tax credit (HCTC), you can buy health insurance from the Alaska Comprehensive Health Insurance Association (ACHIA).
• If you have difficulty obtaining affordable private health insurance because of your health status, you may be able to get coverage from ACHIA. You are eligible to purchase ACHIA coverage if you have lived in Alaska for at least 12 months, are not eligible for a small employer health plan, do not have other health insurance coverage including coverage from a government health plan (such as the Indian Health Service, Veteran’s Administration benefits, or Medicaid), and meet one of the following criteria:

You have been turned down for coverage by one insurance company;

You have been diagnosed with one of a list of health conditions such as cancer, diabetes, heart disease, or AIDS; or

You were offered coverage by an insurance company, but the policy contained a restrictive rider that would have substantially reduced the benefits of the insurance policy.

• ACHIA does not offer family coverage. Each member of your family who wants ACHIA coverage needs to qualify on his or her own.

What will ACHIA cover?

• ACHIA coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, and other services. For most services, the plan will pay for 80% of covered charges after you have satisfied your annual deductible. After you have paid a maximum amount for covered services, ACHIA will pay 100% of your covered charges. Separate coverage limits apply to mental health and substance abuse benefits.

What about coverage for my pre-existing condition?

• If you are HIPAA or HTCT eligible, you will not receive a pre-existing condition exclusion when you enroll in ACHIA. Elimination riders are not permitted on ACHIA plans.
• If you are not HIPAA eligible, you may have a 6-month pre-existing condition exclusion period when you first enroll in ACHIA. When you enroll, ACHIA will look back 3 months to see if you had a condition for which you actually received - or for which most people would have sought - a diagnosis, medical advice, or treatment. This is called the prudent person rule. Pregnancy and genetic information can be considered pre-existing conditions. Elimination riders are not permitted on ACHIA plans.
• ACHIA will credit prior continuous coverage toward your pre-existing condition exclusion if you apply for ACHIA coverage within 31 days of losing your prior coverage. ACHIA will consider your prior coverage creditable if it was involuntarily terminated and contained a similar pre-existing condition exclusion.

What can I be charged for ACHIA coverage?

• Premiums will vary based on the plan you choose. In addition, ACHIA charges enrollees different rates based on their age and the geographic area they live in. Under Alaska law, ACHIA rates are not allowed to be more than 200% of the amount that a healthy person would pay if he or she bought a similar plan sold by a private insurer. In practice, however, ACHIA rates have generally been about 150% to 175% of the rates that healthy people pay.

For example, the monthly premium for a 24-year-old person ranges from $162 to $417, depending on which deductible option is selected.  By contrast, the monthly premium for a 64-year-old person ranges from $583 to $1,506, depending on which deductible option is selected.

Contact ACHIA at (888) 290-0616 or visit http://www.achia.com/ for the most current information about premium and coverage options.

How long does ACHIA coverage last?

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