Oregon maintains a high-risk pool, called the Oregon Medical Insurance Pool (OMIP),to provide insurance for residents of Oregon who are unable to buy private health insurance due to their health conditions, and for people who are HIPAA eligible and TAA eligible. There are several ways you can qualify to buy an individual health insurance policy from OMIP. OMIP offers single party coverage (an adult or child), two party coverage (one adult and one dependent spouse or child), or family coverage. There are limits on what you can be charged by OMIP. Rates are based on choice of plan, age, family size and geography. There are also limits on pre-existing condition exclusion periods that can be imposed.
When can I buy health insurance from OMIP?
· If you had coverage in Oregon under a self-insured group health plan for at least 6 months and apply within 63 days of losing it, you can obtain a portability policy from OMIP. You will first be required to use up any COBRA coverage available to you.
· If you have been covered under a fully insured group health plan issued in another state, apply for coverage within 63 days of losing it, you can buy a portability policy from OMIP.
· If you are HIPAA eligible but not eligible to buy a portability policy from a private insurance company, you can buy coverage from OMIP.
To be HIPAA eligible, you must meet certain criteria
If you are HIPAA eligible you are guaranteed the right to buy some type of individual coverage in every state and you will have no from pre-existing condition exclusion periods. In Oregon you can buy a portability plan from a private insurer or from OMIP.
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.
Federal 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 and not eligible to buy a portability policy, you can buy health insurance from OMIP if you meet other requirements. There are several ways to become eligible:
o You have been turned down for coverage by one insurance company because of a health condition;
o You have been offered coverage by an insurance company that contained a waiver that would substantially reduce your coverage due to an existing health condition;
o You have been diagnosed with a serious condition, such as cancer, AIDS or diabetes, that would limit your ability to purchase health insurance.
· You can also buy health insurance from OMIP if you have been certified as eligible for federal premium assistance under the HCTC. (see Financial Assistance)
What will OMIP cover?
· Health insurance from OMIP includes hospital and physician care, prescription drugs, mental health and other services. Total coverage is limited to a lifetime maximum of $2,000,000.
· OMIP offers 4 plan options. Benefits are the same under all options, but the annual deductible and cost sharing varies. If you are medically eligible, your deductible choices are $500, $750, $1,000 or $1,500. If you are eligible for a portability policy, your deductible choices are $750 or $1,500.
What about coverage for my pre-existing condition?
· OMIP will exclude coverage for your pre-existing condition for 6 months. OMIP will look back 6 months before you enroll to see if you had a condition for which you actually received a diagnosis or treatment. You will get credit for prior coverage if it was involuntarily terminated and you apply for coverage within 63 days of termination. However, if you sign up for coverage under a portability policy through OMIP, you will not have a pre-existing condition exclusion period.
How much can I be charged for OMIP coverage?
· If you qualify for a portability policy through OMIP you will be charged the standard OMIP premium. This is similar to rates normally charged by private insurers for someone your age.
· If you do not qualify for a portability policy, you will pay a “high risk” premium that is 25% higher than the standard OMIP rate.
· Premiums vary depending on your plan choice and age. For example, a 24-year old man would pay $207 per month for a portability policy with a $750 deductible under OMIP, while a 64-year old man would pay $508 per month for the same policy. For a non-portability plan with a $750 deductible, the 24-year old man would pay $271 per month, while the 64-year old man would pay $608 per month. The high risk rate is 25% higher than the portability rate. Contact OMIP for more information about plan options and premiums.
· Contact OMIP for the most current information about premiums and coverage options.
Can my OMIP coverage be canceled?
· OMIP coverage is renewable as long as your pay your premiums, condition to reside in Oregon, and meet other eligibility requirements. If your high risk pool policy is terminated or you cancel it, you will have to wait 12 months before you can reapply for Pool coverage, unless you are HIPAA eligible for HCTC eligible.
