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PPACA: States Firm Up Risk Pool Arrangements

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Montana, New Hampshire and Ohio are some of the states talking about how they will help residents who have a hard time buying individually underwritten health insurance.

The states have issued announcements describing efforts to set up temporary risk pools, or insurance entities that are supposed to provide subsidized, affordable health coverage to individuals shut out of the traditional health insurance market.

Some states already ban or sharply restrict use of health status information in the individual health insurance market, and the new federal Affordable Care Act (ACA) – the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act – is set to ban use of health status information in the individual market starting with plan years that begin in 2014.

The ACA temporary risk pool provisions are supposed to help high-risk individuals in states that permit individual medical underwriting get health coverage between July 1 and 2014.

The program is available to people who have a pre-existing medical condition and have been uninsured for 6 months or more. Rates are not supposed to vary by age by a ratio greater than 4 to 1, and rates are not supposed to be higher than the cost of standard health coverage.

Some states have applied to run their own risk pool programs, and others will be letting the federal government handle the job.

Montana has signed a contract that will let the federal government run a new Montana Affordable Care Plan risk pool.

Montana Commissioner of Securities and Insurance Monica Lindeen says her state’s risk pool should be ready to accept applications July 1. She will be holding a press conference in Helena, Mont., June 30 to unveil the program.

In New Hampshire, the New Hampshire Individual Health Plan Benefit Association, a nonprofit plan run by Benefit Management Inc., Great Bend, Kan., has a federal contract to run New Hampshire’s risk pool

The NHIHPBA already runs an existing New Hampshire risk pool program, officials say.

The new, temporary risk pool program should make coverage available to more state residents, officials say.

Like the risk pool program in Montana, the risk pool program in New Hampshire will be accepting applications starting July 1.

New Hampshire Insurance Commissioner Roger Sevigny has praised the board and staff of NHIHPB for getting the temporary risk pool up and running so quickly. “These folks worked day and night to make an entirely new insurance program available to those with the greatest need in less than 3 months,” Sevigny says. “That is a significant achievement.”

Ohio has picked Medical Mutual of Ohio, Cleveland, to run its temporary risk pool program.

The pool will provide coverage for about 5,000 Ohio residents who now lack health coverage, officials estimate.


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