Wyoming maintains a high risk pool, called the Wyoming Health Insurance Pool or WHIP, to provide insurance for residents of Wyoming with health conditions who are unable to by private health insurance and for people who are HIPAA eligible.
WHEN CAN I GET COVERAGE FROM WHIP?
- You must be a resident of Wyoming.
- You can buy coverage from WHIP if you are “uninsurable”. You are considered “uninsurable” if:
- o You have been turned down for an individual health insurance policy by at least one insurance company because of a health condition; or
- o You are offered an individual health insurance policy with reductions or exclusions more restrictive than WHIP coverage; or
- o You have been offered individual health insurance policy, including coverage under a conversion policy that is more expensive than WHIP coverage.
You only need to show that you are “uninsurable” in one of these ways in order to get WHIP coverage.
- If you are HIPAA eligible, you can buy health insurance from WHIP. You will not have a pre-existing condition exclusion period.
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 with no pre-existing condition exclusion period. In Wyoming, you are only guaranteed the right to buy coverage from WHIP. 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.
- WHIP does not offer family coverage. Each member of your family who wants to enroll in WHIP will have to qualify on his or her own.
- If you are on Medicare disability and cannot obtain a Medigap policy, or if you obtain one but only at rates exceeding the WHIP rates, then you can purchase a Coordination of Benefits (COB) plan through WHIP.
WHAT WILL WHIP COVER?
- WHIP offers 2 plan options. Both plans offer similar benefits (hospital, physician, catastrophic pregnancy, etc.) but with different levels of co-payments and deductibles. Depending on the plan option, WHIP will pay 70% to 80% of covered charges for most services after you have satisfied any deductible. However, separate annual deductibles apply for outpatient medical care, mental health care, and maternity care. In addition, there is a separate deductible for each hospital admission. After you have paid the maximum amount for covered services (also called the out-of-pocket limit), WHIP will pay 100% of covered charges for the remainder of the year.
- WHIP offers two cost sharing options. The Brown Plan limits your out-of-pocket costs for covered services to $4,000 annually and has a maximum lifetime limit of $350,000 per person. The Gold Plan limits your out-of pocket costs for covered services to $2,000 annually and has a lifetime limit of $600,000. The Gold Plan also provides somewhat greater coverage for outpatient rehabilitation and preventative care.
WHAT ABOUT COVERAGE FOR MY PRE-EXISTING CONDITION?
- If you are HIPAA eligible, you will not have a pre-existing condition exclusion when you enroll in WHIP.
- If you are not HIPAA eligible, you may have a 12-month pre-existing condition exclusion period when you first enroll in WHIP. When you enroll, WHIP will look back 6 months to see if you had a condition for which you actually received a diagnosis, medical advice, or treatment- or for which most people would have sought a diagnosis, medical advice, or treatment. Pregnancy can be considered a pre-existing condition.
- WHIP will credit your prior creditable coverage against the pre-existing condition exclusion period, provided that there was not a break in coverage greater than 90 days in a row.
WHAT CAN I BE CHARGED FOR WHIP COVERAGE?
- WHIP premiums are set to be about twice as much as healthy people would pay for similar coverage sold by a private insurer. WHIP premiums will vary based on your age, gender, and the cost sharing option that you choose.
For example, the monthly premium for a 24-year-old single man ranges from $203 to $289, depending on the option he chooses. By contrast, the monthly premium for a 64-year-old single man ranges from $1095.10 to $1560.50, depending on the benefits option he chooses.
- Low or moderate income. You may qualify for reduced plan premiums through an optional state subsidy program. This option is available to individuals earning less than 250% FPL. For more information contact WHIP at (800) 442-2376.
- Premiums are updated each year in July.
HOW LONG DOES WHIP COVERAGE LAST?
- WHIP policies are renewable as long as you pay your premiums, continue to reside in Wyoming, and meet other eligibility requirements.