Major Risk Insurance Plans
You may have heard of them, but what is a Risk Pool? A health insurance risk pool is a program developed by state legislatures to assist people who may be considered “uninsurable” due to having health problems. In most cases these people are not able to obtain health insurance coverage on their own through a private health plan because they have been denied due to a pre-existing health condition or the coverage that is offered is too expensive.
A risk pool is essentially a state-created, non-profit association that is overseen by a board of directors. Most state programs may vary a little in the type of program, but they each function similarly. The board chooses and contracts with an insurance company to administer the program (such as collecting premiums and paying claims.) Most risk pool plans offer some type of 80/20 comprehensive medical coverage with a variety of copayment and deductible options.
Though risk-plans may be a way to obtain health insurance coverage for those in need, there are some key points to consider.
First, the lifetime and annual maximums may be extremely low, such as a $250,000 lifetime maximum and a $50,000 annual maximum. It is foreseeable that patients who require significant medical attention could run out of benefits with a low annual maximum, leaving themselves to pick up the remaining medical expenses out of their own pocket.
Second, the premium could be expensive, with them ranging between 150% to 200% of a standard premium charged for private health insurance. Some states do have laws to limit the amount of the premium rates so that they are not too exorbitant.
Third, there are strict eligibility requirements and it is important that you check with your State Insurance Department to find out if you are eligible. Some states don’t allow individuals to participate if they are eligible for Medicare, Medicaid or COBRA. There is usually a high demand for these types of plans, which may create a waiting list in your state. If you are eligible and have been approved, a waiting period may be applied.
your convenience, we have included the phone numbers for those states
that offer state risk pools.
New Mexico 505-271-4399
North Dakota 800-737-0016
South Carolina 803-788-0222