Mississippi maintains a high risk pool called the Mississippi Comprehensive Health Insurance Risk Pool Association or MCHIRPA.  MCHIRPA provides insurance coverage for residents of Mississippi who, because of health conditions, are unable to obtain private health insurance and for people who are HIPAA eligible.

When can I get coverage from MCHIRPA?

• If you are HIPAA eligible, you can buy health insurance from MCHIRPA. You will not have a pre-existing condition exclusion period.

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.  In Mississippi, you are guaranteed the right to buy coverage only from MCHIRPA.  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.

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 not HIPAA eligible, you can buy coverage from MCHIRPA if you have been a legal Mississippi resident for at least 6 consecutive months and can demonstrate proof of eligibility. To show eligibility, you must either have received a notice of rejection for coverage that is substantially similar to MCHIRPA coverage or have been diagnosed with a health condition (such as cancer or AIDS) that causes insurance companies to automatically reject you for coverage. MCHIRPA requires that you not be eligible for or have other, similar coverage from a private or government health plan (including Medicare and Medicaid).
• You are also eligible for MCHIRPA coverage if you are transferring from another state’s high risk pool. The 6-month residency requirement does not apply to you, but you must send the application to MCHIRPA within 63 days of becoming a Mississippi resident to receive credit for your prior coverage.
• MCHIRPA does not offer family coverage. Each member of your family needs to qualify on his or her own for an MCHIRPA policy.

What will MCHIRPA cover?

• MCHIRPA coverage includes hospital services, physician care, limited mental health care, prescription drugs, and other services. If you are not HIPAA eligible, prescription coverage doesn’t begin until you have been enrolled for 6 months. For most services, the plan will pay for 80% of covered charges after you have satisfied your annual deductible. You can choose a plan option with a deductible of $1,000, $2,000, $3,000, $5,000 or $10,000. MCHIRPA does not have an annual out-of-pocket maximum that limits cost sharing for most services.

What about coverage for my pre-existing condition?

• If you are HIPAA eligible, you will not receive a pre-existing condition exclusion when you enroll in MCHIRPA.
• If you are not HIPAA eligible, you may have a 12-month pre-existing condition exclusion period when you first enroll in MCHIRPA. When you enroll, MCHIRPA will look back 6 months to see if you had a condition for which you actually received a diagnosis, medical advice, or treatment. Pregnancy and genetic information can be considered pre-existing conditions.

MCHIRPA does not credit prior continuous coverage toward pre-existing condition exclusions.  However, if you lost your prior coverage through no fault of your own, you may be able to get credit if you apply for MCHIRPA coverage within 63 days of losing your prior coverage.  

 What can I be charged for MCHIRPA coverage?

• Premiums will vary based on the plan you choose as well as your age and gender. In addition, you will pay more if your coverage does not impose a 12-month pre-existing condition exclusion period. MCHIRPA rates are limited to 175% of the amount that a healthy person would pay if he or she bought a similar plan sold by a private insurer.

For example, when this guide was written, the monthly premium for a policy issued with immediate coverage for pre-existing conditions for a 24 year-old man ranged from $131 to $355, depending on what deductible option he took. The monthly premium for a policy issued with a 12-month pre-existing condition exclusion period for a 24 year-old man ranged from $100 to $266.  By contrast, the monthly premium for a policy issued with immediate coverage for pre-existing conditions for a 64 year-old man ranged from $999 to $366.  The monthly premium for a policy issued with a 12 month pre-existing condition exclusion period for a 64 year-old man ranged from $281 to $753.

How long does MCHIRPA coverage last?

• MCHIRPA policies are renewable as long as you pay your premiums, continue to reside in Mississippi, and meet other eligibility requirements. If your MCHIRPA policy is terminated or you cancel it, you will have to wait 12 months before you can reapply for MCHIRPA coverage.