Some Quick Facts on High-Risk Pools

Within 90 days of health care reform legislation being enacted, the Health and Human Services Secretary will establish a temporary high risk pool that will be open to people unable to obtain coverage due to a pre-existing condition until the Exchange is set up.

Summary

• The Secretary will be establishing programs to help people transfer from the high risk program, which ends January 1, 2014, into the Exchange.
• The Secretary can directly establish the pool or they can contract out
  with the state or a non-profit private entity, such as Blue Cross, to
  administer it.  

High Risk Pool Program Coverage

• Coverage needs to be made available to all eligible participants regardless of pre-existing conditions.
• The insurer must pay a minimum of 65% of all costs related to health services.
• The insurer will not be able to charge their elder population more than 4xs what they charge their youngest healthiest person in the program.
• The Secretary can deem appropriate other requirements to be put on the insurer for fair pricing standards.

Eligibility

To be eligible a person has to:

• Be a citizen, national of the US, or lawfully present in the US.
• Have been uninsured for 6 months.
• Have a pre-existing condition.

Protections against abuse

• Once a State has applied for funding for a high risk pool, to be granted the pool they cannot decrease current funding for any high risk programs.
• Employers that dump employees from their health insurance program or encourage them to unenroll and then enter the high risk pool will have to pay a penalty that goes into the high risk pool.

High-Risk-Pools.pdf