State Health Insurance Pools

A Possible Solution for High Health Risk Individuals

Aug 2, 2007 Felicia A. Williams

High health risk individuals not only feel the pinch of ever increasing insurance premiums, they have the added difficulty of finding a company to insure them.

If you're considered to be in the high-risk medical category, it will be difficult for you to find health insurance through the voluntary insurance market. When you do locate a company that is willing to take on the risk, be prepared to reach a little deeper into your pocket to pay the premiums. Insurance companies are in the business of making money and generally do not like to insure high-risk policyholders.

To get a better understanding of your options, let's take it step by step:

What is considered a high risk individual?

You fall into the high-risk category if you have a pre-existing condition or serious illness that would increase the likelihood of a filing a health insurance claim (generally high-cost claims). High-risk individuals are usually turned down by conventional health insurance companies or charged an exorbitantly high premium.

I've been classified as a high-risk individual, what can I do?

If you've shopped extensively for health insurance and have been quoted an unreasonably high rate or have been turned down as a result of your medical condition, your alternative is to seek coverage offered by a state sponsored health insurance pool.

What is a state sponsored pool?

Many states have a pool of insurers who are willing to provide insurance for high health risk policyholders. To see if your state has a health insurance pool check with your state's insurance department or visit The National Association of State Comprehensive Health Plans website. NASCHP provides information such as links and phone numbers for each participating state's health insurance pool.

How do I qualify for the pool?

• To qualify for insurance under a state's health insurance pool you must live within the state in which you are applying for coverage. If you're considering a move to another state, the coverage will not follow you. You must apply for coverage under the new state's health insurance pool
• You need proof that you have been denied health insurance or are paying premiums higher than those offered through the pool.
• In some cases you may qualify for coverage if your current insurance company has denied claims due to a pre-existing condition. Keep in mind however, that if you apply to the pool for insurance because of a pre-existing condition, the pool may institute a waiting period for any previously uninsured condition.

The health insurance pool is not the cure-all. Each state's rules and regulations vary so make sure you research your state's plan thoroughly. If you can secure insurance elsewhere, then do so because the insurance premiums charged through the pool are not cheap.

For an overview on health insurance pools, read Family USA's brochure High Risk Health Insurance Pools (requires adobe Acrobat Reader).

The copyright of the article State Health Insurance Pools in Insurance is owned by Felicia A. Williams. Permission to republish State Health Insurance Pools in print or online must be granted by the author in writing.

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