Kansas Health Insurance Association

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

· If you are HIPAA eligible, you can buy health insurance from KHIA.

To be HIPAA eligible, you must meet certain criteria

No matter where you live in the U.S., if you are HIPAA eligible you are guaranteed the right to buy individual health coverage of some kind with no pre-existing condition exclusion periods. In Kansas, you are guaranteed the right to buy coverage only from KHIA. 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.)

· You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.

Your HIPAA eligible status ends as soon as you enroll in KHIA or an individual health insurance policy, 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 Health Coverage Tax Credit (HCTC), you can buy insurance from KHIA.

· If you are not HIPAA eligible, you can buy health insurance from KHIA if you have lived in Kansas for at least 6 months and can demonstrate proof of uninsurability. You are considered uninsurable in Kansas if you have been turned down for individual health insurance by 2 different insurers, offered health insurance that permanently excludes coverage for your pre-existing condition, or are unable to find private health insurance coverage that is cheaper than coverage from KHIA.

· You can also buy health insurance from KHIA if you are transferring from another state’s high-risk pool. If you were in a pre-existing exclusion period under the other state’s high-risk pool when it ended, you will have to finish it. You must apply for KHIA coverage within 63 days.

What does KHIA cover?

· You can choose from four plan options under KHIA. Covered benefits are the same under all plans, but the annual deductible varies. You have a choice of an annual deductible ranging from $1,500 to $10,000.

Once you have met your deductible, you will be charged 30% coinsurance for care received from in-network providers. After you pay a maximum amount for covered services (also called out-of-pocket limit) KHIA will pay 100% of the cost of your covered care. If you receive care from out-of-network providers, you will be charged 50% coinsurance and those expenses will not apply toward your out-of-pocket limit.

· Covered benefits include hospital and physician care, prescription drugs, diagnostic tests and x-rays, home health care, and other services. There is a lifetime maximum of $2 million per person on covered benefits.

What about coverage for my pre-existing condition?

· If you are HIPAA eligible or eligible for the Health Coverage Tax Credit (HCTC), you will not have a pre-existing condition exclusion when you enroll in KHIA. Elimination riders are not permitted on KHIA plans.

· If you are not HIPAA eligible, KHIA will exclude coverage for your pre-existing condition for 90 days. However, KHIA will credit prior continuous coverage as long as you apply to KHIA within 31 days of losing your prior coverage.

How much can I be charged for KHIA coverage?

· Premiums vary based on your age, gender, and whether you smoke. For example, for the 2009 plan year, monthly premiums for a 24-year old, non-smoking male range from $132 to $240, depending on the deductible option selected. Monthly premiums for a 64-year old, non-smoking male range from $572 to $1,057 (Note: Family coverage is available for the adult KHIA policyholder and two or more dependents. A child may not be the primary policyholder).

For further information about KHIA rates, visit the KHIA website at http://www.khiastatepool.com or call (800) 362-9290.

How long does coverage last?

· KHIA coverage is renewable as long as you pay your premiums, continue to reside in Kansas, and meet other eligibility requirements.


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