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

When am I eligible for CHAND?

• You can buy coverage from CHAND if you are a North Dakota resident, have lived in North Dakota for at least 6 months, and can demonstrate proof of uninsurability. You are considered uninsurable in North Dakota 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 health insurance with premium rate exceeding the CHAND 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 CHAND 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 insurance of some kind without pre-existing condition exclusion periods. In North Dakota, you are guaranteed the right to buy coverage only from CHAND.  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 bought and 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 CHAND if you have been certified as eligible for federal premium assistance under the Trade Adjustment Act (TAA). TAA eligible individuals are not required to exhaust COBRA continuation coverage and cannot have other health insurance coverage.
• In general, you cannot have CHAND coverage if you are eligible for any other health insurance except Medicare. However, if you are in CHAND and become eligible for another health plan that has a pre-existing condition exclusion period, you can keep your CHAND coverage through the end of that exclusion period. In addition, you cannot have CHAND coverage if you have terminated CHAND coverage during the last 12 months.

What does CHAND cover?

• CHAND currently offers one comprehensive health plan with two different deductible options ($500 or $1000 annually). After the deductible is met, the plan will pay 80% of the allowed charge for covered services. In addition, there is a $3,000 annual limit on your out-of-pocket spending on deductibles and co-insurance. After you reach this limit, CHAND will pay 100% of covered charges for the remainder of the year. Covered services have a lifetime limit of $1 million.
• Covered benefits include hospital and physician care, prescription drugs, home health care, and other services. Preventive services - such as childhood immunizations, mammograms, and screening for prostate cancer - are covered with special conditions.
• If you have Medicare, CHAND also offers a basic and standard supplement plan with its own premium. Call CHAND for more information about their Medicare supplement plan.

What about coverage for my pre-existing condition?

• If you are not HIPAA eligible, CHAND will exclude coverage for your pre-existing condition for 180 days. CHAND will look back 90 days prior to the effective date of your benefit plan to see if you had a condition for which you actually received a diagnosis or medical advice or treatment. Unlike group health plans, CHAND can impose a pre-existing condition exclusion period on pregnancy for 270 days, or, if you have a major illness and also are pregnant, maternity coverage should be available after 180 days. CHAND will give you credit for prior continuous coverage (not interrupted by a break of 63 or more consecutive days) toward your pre-existing condition exclusion.
• If you are HIPAA eligible, CHAND cannot impose any pre-existing condition exclusion periods.

How much can I be charged for CHAND coverage?

• CHAND premiums vary based on your age and the plan you choose. For example, monthly premiums range from $213-$232 for a 24-year old male and $543-$581 for a 64-year old male.

Can my CHAND coverage be cancelled?

• CHAND coverage is renewable as long as you pay your premiums, continue to reside in North Dakota, and meet other eligibility requirements.