Minnesota has a high risk pool called the Minnesota Comprehensive Health Association (MCHA). MCHA provides insurance for people who cannot get individual health insurance or because they have expensive health conditions.

When am I eligible for MCHA?

• In general, you can buy coverage from MCHA if you have lived in Minnesota for at least 6 months and can demonstrate proof of uninsurability. You are considered uninsurable in Minnesota if you have been turned down for individual health insurance within 6 month of application, the insurer excludes coverage for your pre-existing condition, you are diagnosed with one of a list of serious health conditions or are unable to find private health insurance coverage that is cheaper than MCHA health insurance. You can also buy coverage from MCHA when your individual health insurance ends through no fault of your own.
• You can also by coverage from MCHA if you are HIPAA eligible. HIPAA eligible applicants do not have to meet the 6 month residency requirement or prove they are uninsurable.

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 insurance of some kind with no pre-existing condition exclusion periods. In Minnesota, you are guaranteed the right to buy coverage only from MCHA.  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 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 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.

• MCHA offers family coverage. Adults eligible for MCHA can also buy coverage for their spouses and dependents.

What does MCHA cover?

• You can choose from 5 plan options under MCHA. Covered benefits are the same under all plans, but the annual deductible varies. You have a choice of an annual deductible of $500, $1,000, $2,000, $5,000 and $10,000.
• Covered benefits include hospital and physician care, prescription drugs, home health care, and other services. There is a lifetime maximum of $2.8 million per person on covered benefits.

What about coverage for my pre-existing condition?

• If you are not HIPAA eligible, MCHA will exclude coverage for your pre-existing condition for 6 months. MCHA will credit prior, continuous coverage toward this pre-existing condition exclusion period. The definition of continuous coverage under MCHA depends on the type of coverage you had and the reason it ended.

If your prior coverage was an individual health insurance policy that was terminated   and no replacement coverage was provided, you must apply to MCHA within 90 days of that termination for the coverage to be credited toward the MCHA pre-existing condition exclusion period. 

If you prior coverage was under a group health plan and you were terminated and you are not HIPAA eligible, you must apply to MCHA within 90 days for prior coverage to be creditable.

You must apply to MCHA within 90 days for your prior coverage to be considered continuous and creditable for any of the following reasons: your previous insurer became insolvent, you reached the maximum lifetime benefit under your prior coverage, you exhausted state or COBRA continuation coverage, are leaving a medical assistance program, your conversion policy or other coverage was terminated. 

• If you are HIPAA eligible, MCHA will not impose a pre-existing condition exclusion period.

How much can I be charged for MCHA coverage?

• Premiums vary based on your age and the plan you choose. For example, for the 2006 plan year, monthly premiums for the plan with a $500 deductible range from $235 for a 24 year old to $704 for a 64 year old. Monthly premiums for the plan with the $10,000 deductible range from $70 for a 24-year old to $209 for a 64-year old. (Note: Family coverage is available for the adult MCHA policyholder and dependents.)

Contact the Minnesota Department of Commerce or the MCHA plan administrator for information about coverage options and premiums.

How long does MCHA coverage last?

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