Nebraska’s Comprehensive Health Insurance Pool (CHIP)

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Nebraska maintains a high risk pool, called the Comprehensive Health Insurance Pool (CHIP), which provides access to health insurance coverage to all residents of Nebraska who are denied adequate health insurance and are considered uninsurable and for people who are HIPAA eligible.

When am I eligible for CHIP?

You can buy coverage from CHIP if you are a Nebraska resident for at least 6 months and can demonstrate proof of uninsurability. You are considered uninsurable in Nebraska if you have written evidence from at least one insurer that within 6 months prior to applying, you have been:
o turned down for coverage;
o offered health insurance that restricts or excludes coverage for your pre-existing condition;
o offered comparable health insurance with premium rate exceeding the CHIP rate; or
o diagnosed and have written evidence from a medical professional of the existence of a qualifying condition.
In addition, if you are HIPAA eligible, you can buy health insurance from CHIP without limits on coverage for pre-existing conditions.

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 Nebraska, you are guaranteed the right to buy coverage only from Nebraska Comprehensive Health Insurance Pool (CHIP). 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 individual health insurance, 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.

You can also buy coverage from CHIP if you have been certified as eligible for federal premium assistance under the HCTC. HCTC eligible individuals are not required to exhaust COBRA continuation coverage and cannot have other health insurance coverage.

What does CHIP cover?

CHIP currently offers a PPO product with a choice of eight calendar year deductibles ranging from $250 to $5,000. After the deductible is met, the plan will pay 80% of the allowed charges for covered services. In addition, there is a $1,500 annual limit on your out-of-pocket spending on deductibles and coinsurance. After you reach this limit, CHIP will pay 100% of covered charges for the remainder of the year. Covered services have a lifetime limit of $1 million.
CHIP coverage includes hospital and physician care, prescription drugs, physical, speech, and occupational therapies, x-ray and lab, home health care, and other services. A limited maternity benefit is offered for an additional premium.

What about coverage for my pre-existing condition?

If you are HIPAA eligible, you will not have a pre-existing condition exclusion period.
If you are not HIPAA eligible, CHIP will exclude coverage for your pre-existing condition for 6 months following the effective date of coverage as to any condition that had manifested itself or for which medical advice, care or treatment was recommended or received during the 6-month period prior to the effective date of your CHIP coverage.
Even if you don’t have 6 months of prior coverage, your pre-existing condition exclusion period may be waived if you were involuntarily terminated from your previous job. Your pre-existing condition exclusion period also may be waived under certain circumstances. For example, if your health coverage was involuntarily terminated because of the withdrawal by the insurer from the state, the bankruptcy or insolvency of your employer or employer trust fund, or your employer ceases to provide any group health plan for all its employees. You must apply for the pre-existing waiver within 60 days after the termination of prior coverage.

Pre-existing condition exclusion period may be waived under other qualifying events. Contact the Nebraska Department of Insurance for more information.

How much can I be charged for CHIP coverage?

CHIP premiums vary based on the deductible level you choose, your gender, age, where you live, and whether you smoke. Premiums are generally set at 135 percent of the typical rate for individual coverage in Nebraska. For example, monthly premiums range from $147-384 for a non-smoker, 24-year old male in Omaha and $595-$1,410 for a non-smoker, 64-year old male. These figures are current as of the writing of this guide. Check with CHIP for the most up-to-date information on premium rates and plan options.

How long does coverage last?

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

Nebraska