New Hampshire has a risk pool program that went into effect on July 1, 2002 called the New Hampshire Health Plan.  The high risk pool offers health coverage for persons who are HIPAA eligible and for people with expensive health conditions who are unable to buy individual coverage.

When can I get coverage from the New Hampshire Health Plan?

• If you are HIPAA eligible, you can buy health insurance from the New Hampshire Health Plan.

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 an individual health insurance policy of some kind with no pre-existing condition exclusion periods. In New Hampshire, you are guaranteed the right to buy coverage only from the high risk pool.  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 health insurance from the New Hampshire Health Plan if you were turned down for coverage by an insurer or HMO because of your health or were offered an insurance policy by an insurer or HMO, but it would have been more expensive than buying health insurance from the New Hampshire Health Plan.

In addition, if you have a pre-qualifying medical condition, you do not have to first apply to a private carrier before applying for coverage. This list maybe amended from time to time by the New Hampshire Health Plan board.  You should check the webpage for an updated list of pre-qualifying conditions.

• The New Hampshire Health Plan offers coverage to those that are eligible and their dependents and spouse. However, each person must purchase his own individual policy.

What will the new Hampshire Health Plan cover?

• Health insurance from the New Hampshire Health Plan includes hospital and physician care, maternity services, prescription drugs, treatment for serious mental health illness, and other services. Four plan options are available with varying deductibles and coinsurance maximums. The high risk pool offers both indemnity and managed care plan options. In the indemnity plan you can receive care from any provider. The high risk pool pays a percentage of the expenses for covered services. In the managed care plan a higher percentage of the cost of care will be covered when you see a provider within the network instead of a provider outside the network.

What about coverage for my pre-existing condition?

• If you are HIPAA eligible, your coverage will not be subject to a pre-existing condition exclusion when you enroll in the New Hampshire Health Plan.
• If you are not HIPAA eligible, you may have a 9 month pre-existing condition exclusion period when you first enroll in the New Hampshire Health Plan. When you enroll, the New Hampshire Health Plan will look back 3 months to see if you had a condition for which you actually received a diagnosis, medical advice, or treatment. Pregnancy can be considered a pre-existing condition. Elimination riders are not permitted.

If your break in coverage is less than 63 days, the New Hampshire Health Plan will give you credit for any coverage that was in effect prior to the effective date of your high risk pool coverage.  The New Hampshire Health Plan considers creditable coverage to include most types of prior individual health insurance or group health plan that you may have had.

What can I be charged for new hampshire health plan coverage?

• Premiums will vary based on the health plan you choose, your age and whether you smoke. High risk pool rates are limited to 150% of the amount that a healthy person who bought a similar policy sold by a private insurer would pay.

For example, a 24-year-old man who was a non-smoker would pay $148 to $242 in monthly premiums, depending on which plan option he chose.  On the other hand, a 64-year-old man who was a non-smoker would pay $582 to $950 in monthly premiums, depending on the plan option he chose.  Please note that high risk pool rates may have changed since this guide was written, so contact the pool administrator for the most current information.

How long does New Hampshire Health Plan coverage last?

• Health insurance from the New Hampshire Health Plan is renewable as long as you pay your premiums, continue to reside in New Hampshire, and meet other eligibility requirements.