Missouri has a high risk pool program, called the Missouri Health Insurance Program (MHIP), which offers insurance for people with health conditions who are unable to buy private health insurance. Individuals leaving group coverage who have exhausted their state continuation coverage or COBRA are also eligible for MHIP.
When can I get coverage from MHIP?
- If you have had difficulty obtaining affordable private health insurance because of your health status, you may be able to purchase MHIP coverage. You are eligible to purchase MHIP coverage if you are a Missouri resident and you are not eligible for Medicare, Medicaid, or a private health plan (unless it would cost you more than 300% of the standard rate). You must also meet one of the following conditions:
- o You have been turned down for coverage by an insurance company within the past 6 months because of a current or pre-existing medical condition;
- o You were involuntarily terminated from your prior coverage and have been unable to find or were turned down for new private coverage;
- o You were accepted for coverage by an insurance company, but your premiums would have been in excess of 300% of the standard rate;
- o You were offered coverage by an insurance company, but the policy contained an elimination rider that would have substantially reduced the benefits of the insurance policy; or
- o You were previously covered under an employer’s group health plan and exhausted any available state continuation coverage or COBRA and have attained the maximum coverage period. You must apply for MHIP within 60 days of the end of your state continuation coverage or COBRA.
- MHIP does not offer family coverage, so each member of your family who wants MHIP coverage needs to qualify on his or her own.
What will MHIP cover?
- MHIP coverage includes hospital and physician care, home health care, maternity care, prescription drugs, and other services. Limited drug and alcohol abuse services are included. For most services, the plan will pay for 80% of covered charges after you have satisfied your annual deductible if your receive care in-network. After you have paid a maximum amount of coinsurance charges for covered in-network services, MHIP will pay 100% of your covered charges for the rest of the calendar year. Less generous payment rules apply to care received from non-network providers inside the plan’s service area, and care received outside the plan’s service area is only covered if it is received during the course of an emergency. Separate coverage limits also apply to mental health and substance abuse benefits.
What about coverage for my pre-existing condition?
- You may have a 12-month pre-existing condition exclusion period when you first enroll in MHIP. When you enroll, MHIP will look back 6 months to see if you had a condition for which you actually received a diagnosis, medical advice, or treatment, or a condition that you knew about. In most cases, pregnancy can be considered a pre-existing condition. Elimination riders are not permitted on MHIP plans.
MHIP will credit prior continuous coverage toward your pre-existing condition exclusion if you apply for MHIP coverage within 60 days of involuntarily losing your prior coverage. MHIP will consider your prior coverage creditable if it was involuntarily terminated and contained a similar pre-existing condition exclusion.
MHIP will also waive your pre-existing condition exclusion period if your previous health insurance coverage premium was in excess of 300% of the standard insurance rate and you enroll in the MHIP plan immediately following the termination of your prior coverage.
- The MHIP pre-existing exclusion does not apply to the prescription drug benefit. Your prescription drug benefit is effective immediately upon your MHIP coverage effective date.
What can I be charged for MHIP coverage?
- Premiums will vary based on the plan you choose. MHIP offers deductible options of $500, $1000, $2500, and $5000. In addition, MHIP charges enrollees different rates based on their age, sex, and the deductible level they choose. Under Missouri law, MHIP rates are not allowed to be more than twice of the amount that a healthy person would pay if he or she bought a similar plan sold by one of the state’s five largest insurers.
For example, for 2006, the monthly premium for a 24-year-old man ranges from $142 to $303, depending on which deductible option is selected. By contrast, the monthly premium for a 64-year-old man ranges from $623 to $1267, depending on which deductible option is selected.
Contact MHIP for the most current information about premium and coverage options.
How long does MHIP coverage last?
- MHIP policies are renewable as long as you pay your premiums, continue to reside in Missouri, and meet other eligibility requirements.