PUBLISHED: July 19, 2010
R.I. high-risk pool health insurance plan starts Oct. 1, with sign-up starting Aug. 15
Marion Davis | Providence Business News | Link to article
PROVIDENCE - Rhode Island's high-risk pool health insurance plan, subsidized by a federal fund created as part of health care reform, is expected to start enrolling members on Aug. 15 for coverage to begin Oct. 1, Health Insurance Commissioner Christopher F. Koller said last week.
The plan is being run by Blue Cross & Blue Shield of Rhode Island, the only insurer serving the individual market in the state. Company officials have said they are creating a special rate pool within their existing Direct Pay product line, which includes several options.
Koller officially designated Blue Cross as the administrator of Rhode Island's high-risk pool funds in a June 25 letter to the U.S. Department of Health and Human Services in which he also reiterated a key condition for the state's participation in the program: that the state "will have no legal or contractual responsibility either now or in the future" to the federal government, Blue Cross, or anyone receiving benefits through the program.
Additional details on the Rhode Island plan were not available last week. (Click here for previous coverage of this issue.)
Federal officials launched the national Pre-existing Condition Insurance Plan on July 1. States had a choice of running their own programs, or letting their residents use the federal program; the District of Columbia and 29 states, including Rhode Island, are setting up their own plans, while 21, including Massachusetts, opted for the federal plan.
In either case, to qualify for coverage, a person must have been uninsured for at least six months, have been unable to get health coverage because of a health condition (prohibitively high rates qualify), and be a U.S. citizen or legal U.S. resident.
Rhode Island law already requires insurers to take all comers and tightly regulates the individual market, but the rates can still be very high: While the average Direct Pay monthly premium is now $518.26, and rates for the young and healthy can be as low as $100.43, for older and sicker members, they can be as much as $1,117.31.
The "pre-existing conditions" insurance program is a "transitional" measure until 2014, when insurers nationwide will be banned from denying coverage to adults with pre-existing conditions; the ban for children goes into effect this September.
Starting in 2014, there will be health insurance exchanges in all the states through which small businesses and individuals can shop for coverage, tightly regulated by the government.
The health care reform law provided $5 billion in federal funding for these plans. Rhode Island's share is about $13 million, which Koller and a Blue Cross official have said is enough to cover about 500 people through 2013.
For the federal plan, which Rhode Islanders cannot enroll in, but which eligible Massachusetts residents can use, an HHS website says there will be a $2,500 deductible (except for preventive services), plus a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20-percent cosharing of the cost of any other covered benefits, with a maximum out-of-pocket cost of $5,950 per year within the plan's network.
More information for consumers is available at HealthCare.gov.