PA Submits High Risk Pool Proposal to HHS

Two weeks ago the Pennsylvania Department of Insurance submitted their High Risk Pool Proposal. If approved Pennsylvanian's will be able to start enrolling on August 1st. A brief summary can be found below. For more information please join us for a special conference call on the High Risk Pools on June 23rd from 6:00pm -7:00pm. Please rsvp to aford@philaup.org for the call in number.

The High Risk Pool will cover on average 5,100 people from 2010-2013 HHS will award contract by July 1st Enrolment will begin August 1st

Eligibility:
An individual must be a resident of the Commonwealth of Pennsylvania and meet all of the following requirements:
1. Is a citizen or national of the United States or is lawfully present in the United States,
as required by the federal Act.
2. Has not been covered under creditable coverage during the six-month period prior to
the date the individual is applying for coverage under the Program.
3. Has evidence that the individual has one of the following:
a. A pre-existing condition, as identified on a list promulgated by the
Department
b. Denial of health insurance coverage due to a pre-existing condition.
c. Coverage is available only with the exclusion of a pre-existing condition.
d. Health insurance coverage was quoted at a substandard rate for a product due
to a pre-existing condition
An individual is ineligible for coverage in PA if eligible for Medicare, Medicaid, Chip or private market health insurance with benefits that are actuarial of at least 90% of the programs benefits and costs no more that 150% of the programs premiums

Benefits:
- Includes prescription drug and serious mental health coverage
- Preventative care is 100% covered in network. This includes annual physical examinations, annual mammograms and gynecological l exams
- For in network use there is a $5,000 annual out of pocket max and no lifetime limits
- 80% of Emergency room visits are covered after the yearly deductible
- $1,000 yearly deductible

Premiums:
- Individuals who fall under 200% of the FPL will pay $168 a month
- Individuals over 200% of the FPL will pay $468 a month