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Turned Down for Coverage

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Options for Minnesotans who have been denied coverage

Historically, health plans have made decisions about whether to approve or deny coverage based on the applicant’s health history.  Under health reform, this is changing.  Health insurance companies can no longer deny coverage based on a child's health condition.  In 2014, this will change for adults too-- insurance companies will not be able to deny coverage or charge more if you have a health condition.

In the meantime, individuals with health conditions have options available including:

·         the Minnesota Comprehensive Health Association (MCHA),

·         the Preexisting Condition Health Insurance Plan (PCIP) and

·         Minnesota Health Care Programs.

I was turned down for health coverage by one insurance company. I feel I am healthy. If I am turned down for coverage by one company, does that automatically mean I will be turned down by other companies?

Not necessarily.  Each insurance company has its own underwriting guidelines for determining whether they will accept someone with a particular health condition.  You may want to check with another company to find out what that company’s guidelines are for accepting people with your health history.   You may also want to talk to the company that denied your application and find out if there is any additional information you can provide that would change their decision.

What if I cannot find a health insurance company in the private market that will cover me?

There are several alternatives for coverage, including the Minnesota Comprehensive Health Association (MCHA), the Preexisting Condition Insurance Plan (PCIP), and Minnesota health care programs.

What is the Minnesota Comprehensive Health Association (MCHA)?

MCHA was established in 1976 by the Minnesota Legislature.  MCHA offers coverage to Minnesota residents who are turned down for health insurance in the private market.  MCHA is sometimes referred to as Minnesota’s high-risk pool for health insurance.  Currently, more than 27,000 Minnesota residents are insured by MCHA throughout the State of Minnesota.

What do I do if I can’t afford these premiums?

If a person has limited income and resources, they may be eligible for one of the Minnesota Health Care Programs through the Minnesota Department of Human Services.  These programs include Medical Assistance, MinnesotaCare, and more.

I was turned down for health coverage by one insurance company. I feel I am healthy. If I am turned down for coverage by one company, does that automatically mean I will be turned down by other companies?

Not necessarily. Each insurance company has its own underwriting guidelines for determining whether they will accept someone with a particular health condition. You may want to check with another company to find out what that company’s guidelines are for accepting people with your health history. You may also want to talk to the company that denied your application and find out if there is any additional information you can provide that would change their decision.

What if I cannot find a health insurance company in the private market that will cover me?

There are several alternatives for coverage, including the Minnesota Comprehensive Health Association (MCHA), the Preexisting Condition Insurance Plan (PCIP), and Minnesota health care programs.

What is the Minnesota Comprehensive Health Association (MCHA)?

MCHA was established in 1976 by the Minnesota Legislature. MCHA offers coverage to Minnesota residents who are turned down for health insurance in the private market. MCHA is sometimes referred to as Minnesota’s high-risk pool for health insurance. Currently, more than 27,000 Minnesota residents are insured by MCHA throughout the State of Minnesota.

What is the Preexisting Condition Insurance Plan (PCIP)?

The Preexisting Condition Insurance Plan (PCIP) was created by the Affordable Care Act. PCIP is a federal program to make health insurance available to people who have been denied coverage by private insurance companies because of a preexisting condition. The program is designed to be temporary until other insurance reforms begin on January 1, 2014.

Who is eligible for the Preexisting Condition Insurance Plan?

•             You must be a citizen or national of the United States or reside in the U.S. legally.

•             You must have been without health coverage for at least the last six months.

•             You must have a preexisting condition or have been denied coverage because of a health condition.

How is MCHA's eligibility different from the federal PCIP plan?

One significant difference is that the federal PCIP plan is only available to people who have been without coverage for at least 6 months.  MCHA does not require people to go 6 months without coverage in order to be eligible to join the state pool.
There are a number of ways that a person can become eligible for MCHA, including exhaustion of their COBRA coverage, exhaustion of their previous policy’s annual or lifetime maximum or loss of group coverage due to an employer’s bankruptcy.  More information on MCHA’s eligibility criteria is available on MCHA’s website at http://www.mchamn.com

Are current MCHA enrollees able to join the PCIP plan?

No.  Current MCHA enrollees would not be eligible for the PCIP plan.  Applicants for PCIP coverage have to be uninsured for at least six months prior to application.

How is funding for the federal Preexisting Condition Insurance Plan (PCIP) different than our state high-risk pool, the Minnesota Comprehensive Health Association (MCHA)?

The current MCHA program is funded by a combination of member premiums and an assessment on health insurance companies.  The federal PCIP plans are funded by a combination of member premiums and funds from the federal government.

How much do plans in MCHA cost?

MCHA provides rate information on its website: http://www.mchamn.com/.  By Minnesota law, MCHA premium rates must be set between one and 25 percent above the average premiums in the private market for comparable plans.  Currently, MCHA rates are set at approximately 15 percent above the average premiums in the private market for comparable plans.

How much do plans in the PCIP program cost?

PCIP provides rate information for each state on its website: https://pcip.gov .  The Affordable Care Act requires premiums for the PCIP plans to be equal to the average premiums in the private market for comparable plans.

What do I do if I can’t afford these premiums?

If a person has limited income and resources, they may be eligible for one of the Minnesota Health Care Programs through the Minnesota Department of Human Services. These programs include Medical Assistance, MinnesotaCare, and more.

How much money has been set aside for Minnesotans in the federal PCIP plan?

Of the $5 billion appropriated for PCIP, $68 million is available to cover uninsured Minnesota residents.

Why does the state continue to offer a state high-risk pool if there is a federal pool available?

MCHA is still needed because the two pools have different eligibility rules.  There are people who are eligible for MCHA who do not qualify for the plans through the PCIP.

How long may I stay in the temporary federal high-risk pool (PCIP plan)?

The temporary federal high-risk pool will terminate on Jan. 1, 2014.  At that time, private insurance companies will not be able to deny coverage for preexisting conditions and an Exchange will be established.  Members enrolled in both the temporary federal high-risk pool and in MCHA will be able to transition to private insurance plans at that time without concern about being denied due to a preexisting condition.