Iowa maintains a high-risk pool, called the Iowa Comprehensive Health Association (HIP-IOWA).  HIP-IOWA provides health coverage for residents who are HIPAA eligible, for residents eligible for HCTC, and for residents with expensive health conditions who are unable to buy individual health insurance.

When am I eligible for HIP-IOWA?

• You can buy health insurance coverage from HIP-IOWA if you are an Iowa resident for at least 6 months and can demonstrate proof of uninsurability. You are considered uninsurable in Iowa if you have written evidence that you have been:
• o denied coverage because of your health status within the last 9 months;
• o offered health insurance that restricts or excludes coverage for your pre-existing condition within the last 9 months;
• o offered health insurance with premiums exceeding the HIP-IOWA rate within the last nine months; or
• o diagnosed with one of a list of serious health conditions (such as cancer or AIDS).

In addition, you must not be eligible for health insurance through a group plan or Medicare or Medicaid. 

• You can also buy coverage from HIP-Iowa if you are HIPAA eligible. The 6-month residency requirement does not apply when you are HIPAA eligible.

To be HIPAA eligible, you must meet certain criteria:

If you are HIPAA eligible, you are guaranteed the right to buy some kind of individual health insurance without any pre-existing condition exclusion periods.  In Iowa, you are only guaranteed the right to by individual coverage through HIP-IOWA. 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.
• You must apply for health insurance for which you are federally 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.

• If you are a current Basic and Standard policy holder, you have the option to purchase coverage from HIP-IOWA or maintain your current coverage.
• You can also buy coverage from HIP-IOWA if you have been certified as eligible for federal premium assistance under HCTC.

What will HIP-IOWA health insurance coverage cover?

• HIP-IOWA coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, home health care, and other services. HIP-IOWA does not cover routine maternity care. However, you have the option of adding coverage for maternity benefits for an additional premium.
• HIP-IOWA offers you the choice of three cost sharing arrangements. The annual deductible options are $1,000, $1,500 and $2,500.
• Following the payment of your deductible, for most services, you will be charged 20% coinsurance for care. After you pay a maximum amount for covered services (also called out-of-pocket limit), HIP-IOWA will pay 100% of the cost of your covered care for the rest of the year. HIP-IOWA has a lifetime limit of $3 million.
• HIP-IOWA also offers a Medicare supplement plan.

What about my pre-existing condition?

• If you are HIPAA eligible, HIP-IOWA cannot impose a pre-existing condition exclusion period.
• If you are not HIPAA eligible, HIP-IOWA will exclude coverage for your pre-existing condition for 180 days. When you enroll, HIP-IOWA will look back 180 days prior to the effective date of your benefit plan to see if you had a condition for which you actually received medical advice, diagnosis, care or treatment.

HIP-IOWA will not credit your prior coverage against this pre-existing condition exclusion period unless your prior coverage was terminated involuntarily and you apply for HIP-IOWA coverage within 63 days of losing your prior coverage.

What can I be charged for my HIP-IOWA health insurance coverage?

• HIP-IOWA premiums vary depending on your age and the deductible you choose.

For example, as of January 1, 2005, the monthly premium for a 24-year-old single, non-smoking male range between $185 to $233, depending on the deductible. By contrast, the monthly premium for a 64-year-old non-smoking single male range from $648 to $816, depending on the deductible.

• Contact the HIP-IOWA plan administrator at (877) 793-6880 for more information about HIP-IOWA premiums and eligibility.

How long does HIP-IOWA coverage last?

• HIP-IOWA coverage is renewable as long as you pay your premium, continue to reside in Iowa, and meet other eligibility requirements.