Indiana Comprehensive Health Insurance Association. Program Overview

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1 Indiana Comprehensive Health Insurance Association Program Overview

2 Eligibility ICHIA was designed to cover eligible citizens with pre-existing medical conditions and the chronically ill obtain comprehensive health insurance coverage in Indiana A person other than a federally eligible individual (i.e. having portability rights under HIPAA) may apply for ICHIA AFTER the person has applied for: Medicaid The Federal Preexisting Condition Insurance Plan (PCIP) The Healthy Indiana Plan (HIP)

3 Eligibility To Be Eligible for ICHIA, a person must must meet ONE of the eligibility categories and the general requirement. Eligibility Categories: 1. Federally Eligible (HIPAA Portability Rights) 2. Rejection for Other Health Coverage Due to Medical Condition 3. Premium Rate Higher than ICHIA

4 Federal Eligibility To be Federally Eligible a person applying must have creditable coverage for at least 18 months with no lapse in coverage exceeding 63 days which meets ALL the following requirements: The coverage was a group plan through employer or union The person is not eligible for coverage under any other group health plan The person does not have other health insurance The person is not eligible for Medicaid The person did not lose insurance for not paying the premiums or for committing fraud The person must have exhausted COBRA benefits of offered.

5 Rejection for Other Coverage To be Eligible through Rejection for Other Coverage A person must have received notification of rejection from a health insurer for coverage that equals or exceeds the MINIMUM requirements for accident or sickness insurance policies issued in Indiana.

6 Premium Rate Higher than ICHIA To be Eligible through a Premium Rate Higher than ICHIA: A person must received a premium notice for health insurance coverage exceeding the premium rate for coverage by ICHIA. The person must not be eligible for any coverage that equals or exceeds the minimum requirements for accident and sickness policies in Indiana.

7 General Eligibility Requirements To Be Eligible for ICHIA, a person must must meet the general requirement. General Requirement 1. A person must be a resident of the State of Indiana for 12 months minimum. (This does NOT apply to the Federally Eligible Category)

8 Dependent Eligibility Coverage for a member s spouse and / or children is also available based on a Limiting Age requirement. An unmarried dependent child s coverage will terminate on the earlier of the child s 24th birthday, or the child s 25th birthday, if the child is a full-time student in an accredited high school, technical or vocational school, or college or university and is chiefly dependent on you for support and maintenance. Attainment of the limiting age will not terminate a child s coverage if the child is: Incapable of self-sustaining employment by reason of mental retardation or mental or physical disability Chiefly dependent on the member for support and maintenance. 1.

9 Dependent Eligibility Newborn Children: A member s newborn child is automatically covered for the first 31 days after birth. Adopted Children: Coverage for newly adopted children will be the same as for other dependents. Coverage for an adopted child is effective upon the earlier of: the date of placement for the purpose of adoption the date of the entry of an order granting custody of a child for purposes of adoption continues unless the placement is disrupted prior to legal adoption and the child is removed from placement for 31 days.

10 Summary of Benefits Five Plans Available to Members: Plan 1 - $500 Deductible (Rx add on option with $550 Deductible) Plan 2 - $1000 Deductible (Rx add on option with $450 Deductible) Plan 3 - $1500 Deductible (Rx add on option with $550 Deductible) Plan 4 - $2500 Deductible shared medical and pharmacy deductible Plan 5 - $5000 Deductible shared medical and pharmacy deductible

11 Summary of Benefits Comprehensive Major Medical Policy Benefit Structure Out of Pocket Limits No Lifetime or Annual Maximums Variable Maximums on Specific Benefits

12 Benefit Structure In Network and Out of Network Benefit Differential Benefit Structure (PPO Network Anthem Wellpoint PPO, Largest and most recognized network of providers in the State) Centers of Excellence Out of Network Negotiations and Bill Review 3 tier RX Copay Structure (Driving Brand and Mail Order Usage) Targeted and Individualized Disease Management Programs (Enhanced Care, Complex Care, HIV, Hemophilia, Depression / Behavioral Health)

13 Rate Development Age / Gender Banded Rating Premium rates must be equal to one hundred fifty percent (150%) of the average premium rate for that class charged by the five (5) carriers with the largest premium volume in the state during the preceding calendar year. The average rate is developed by actuarially adjusting the top 5 carrier rates to determine charges for identical benefits offered through ICHIA. Rate changes must be submitted to commissioner for approval.

14 Program Funding Premiums of ICHIA members. Twenty-five percent (25%) of the net loss is assessed to members (organizations offering individual insurance in the state) as reported to the department of insurance received in Indiana during the calendar year. Seventy-five percent (75%) of any net loss shall is paid by the state.

15 Member Services Regular Member Communications Online Access to Claims, Member Services, Applications, Forms, etc. Interactive and Informative Website

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