Indiana Comprehensive Health Insurance Association (ICHIA)

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Indiana has a high risk pool program, called the Indiana Comprehensive Health Insurance Association (ICHIA) that offers insurance for people with health conditions who are unable to buy private health insurance coverage and for people who are HIPAA eligible. ICHIA is also considered a qualified health plan for individuals eligible for the health coverage tax credit (HCTC). (see Financial Assistance)

When can I get coverage from ICHIA?

· If you are HIPAA eligible, you can purchase an individual health insurance policy from ICHIA.

To be HIPAA eligible, you must meet certain criteria

If you are HIPAA eligible in Indiana, you are guaranteed the right to buy an individual insurance policy plan from ICHIA 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 HIPAA eligible.)

· You must apply for ICHIA coverage within 63 days of losing your prior coverage.

HIPAA eligibility ends when you enroll in ICHIA or individual health insurance, 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 HCTC, you can purchase an individual health insurance policy from ICHIA.

· If you are not HIPAA eligible, you can buy coverage from ICHIA if you are “uninsurable.” You are considered uninsurable if you: 1) have been turned down for coverage that is similar to ICHIA coverage; or 2) are unable to find private health insurance coverage that is cheaper than ICHIA health insurance.

In addition, to buy coverage from ICHIA you must be an Indiana resident for at least 12 months and not be eligible for Medicaid or any other health insurance coverage.

· ICHIA offers family coverage. However, ICHIA does not offer family rates. Each enrolled family member will have to pay the monthly rate based on his or her age and gender.

What will ICHIA cover?

· ICHIA coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, and other services.

· ICHIA offers you a choice of four cost-sharing arrangements. The annual deductible options are $500, $1,000, $1,500, or $2,500.

All four ICHIA plans have a Preferred Provider Network (PPN) of doctors and hospitals in your area. Generally for most services, you will be charged 20% coinsurance for care from a PPN provider and 40% coinsurance for care from a non-PPN provider. After you have paid a maximum amount for covered services (also called the out-of-pocket limit) ICHIA will pay 100% of the eligible expenses for the remainder of the calendar year. ICHIA’s out-of-pocket limits range from $1,500 to $5,000. Plans offered through ICHIA do not impose a lifetime benefit maximum on covered benefits.

Separate coverage limits apply to mental health and substance abuse benefits.

What about coverage for my pre-existing condition?

· If you are HIPAA eligible, you will not have a pre-existing condition exclusion when you enroll in ICHIA. Elimination riders are not permitted on ICHIA plans.

· If you are not HIPAA eligible, ICHIA will exclude coverage for your pre-existing condition for 3 months. ICHIA will look back 3 months before you enrolled to see if you had a condition for which you actually received a diagnosis, medical advice, or treatment. ICHIA can impose pre-existing condition exclusions on pregnancy.

ICHIA will credit prior continuous coverage toward your pre-existing condition exclusion if you apply for ICHIA coverage within 6 months of losing your prior coverage.

What can I be charged for ICHIA coverage?

· ICHIA charges enrollees different rates based on their age, gender and the geographic area they live in. Under Indiana law, ICHIA rates are not allowed to be more than 150% of the amount that a healthy person would pay if he or she bought a similar plan sold by a private insurer.

· In addition, premiums vary based on the plan you choose. For example, the monthly premium for a 24-year-old male ranges from $234 to $285, depending on which plan option is selected and where you live. By contrast, the monthly premium for a 64-year-old male ranges from $807 to $984, depending on which plan option is selected and where you live.

Contact ICHIA for the most current information about premium and coverage options.

How long does ICHIA coverage last?

· ICHIA policies are renewable as long as you pay your premiums, continue to reside in Indiana, and meet other eligibility requirements.


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