Arkansas Health Insurance Coverage...
What is the Arkansas Comprehensive Heatlh Insurance Pool (CHIP) Coverage?
- If you are federally eligible, you can buy health insurance from CHIP.
- If you are not federally eligible, you can buy coverage from CHIP if you have lived
in Arkansas for at least 30 days and can demonstrate proof of eligibility.
There are
several different ways to show eligibility:
1. You have been turned down for coverage by an insurance company;
2. You were offered coverage by an insurance company, but the policy cost more than a
CHIP policy; or
2a. You have a condition that appears on the list published by CHIP that makes you
automatically eligible for CHIP coverage.
You only need to show that you are eligible in one of these ways in order to get
CHIP coverage. CHIP requires that you not be eligible for or already have similar
coverage from another health plan in order to get CHIP coverage.
- CHIP only offers individual coverage, so each member of your family needs to
qualify on his or her own for a CHIP policy.
- CHIP coverage is offered through a managed care plan.
After you satisfy your
annual deductible, the plan will pay 80% of covered charges when you get care from
a hospital, doctor, or other provider in the CHIP network. After charges exceed an
“out-of-pocket” limit, CHIP will pay 100% of covered charges. If you get care from
a provider outside the network, CHIP will pay 60% of covered services, after you
satisfy your annual deductible. The remaining charges will not count toward the
“out-of-pocket” limit.
- CHIP offers 3 deductible options.
Your annual deductible can be $1,000, $5,000, or
$10,000. Different out-of-pocket limits accompany these deductibles. Your out-of-pocket
limit will be $5,000 (with the $1,000 deductible) $25,000 (with the $5,000
deductible), or $50,000 (with the $10,000 deductible).
- Covered benefits include hospital and nursing facility care, physician care, and
prescription drugs.
There are special limits on treatment for mental disorders and chemical dependency. Routine maternity coverage can be purchased for an additional
premium. There is a lifetime limit of $1 million on all covered benefits.
- WHAT ABOUT COVERAGE FOR MY PRE-EXISTING CONDITION?
- If you are federally eligible, you will not receive a pre-existing condition exclusion
when you enroll in CHIP.
- If you are not federally eligible, you may have a 6-month pre-existing condition
exclusion period when you first enroll in CHIP.
When you enroll, CHIP will look back 6 months to see if you had a condition for which you actually received – or for
which most people would have sought – a diagnosis, medical advice, or treatment.
This is called the prudent person rule. Pregnancy and genetic information can be
considered pre-existing conditions.
- If you are not federally eligible, CHIP may waive your pre-existing condition
exclusion period if you meet certain conditions.
You must have had at least 6
months of prior group coverage that was involuntarily terminated, and you must have
satisfied a similar pre-existing condition exclusion under your prior coverage. You
must apply for CHIP not later than 30 days following the involuntary termination,
and you must be ineligible for continuation coverage. CHIP will also require that
you pay a 10% surcharge on your premiums for 5 years.
- If you are looking for some more information regarding policy rates and your rights under your state or federal health care laws, then you can continue your research by visiting the following convenient link.
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