Pre-Existing Condition Insurance Plan - Federal High Risk Pool
Coverage for Medically Uninsurable Available in South Dakota
- Provides coverage which can be purchased for eligible uninsurable citizens.
- Program created by the Patient Protection and Affordable Care Act (PPACA).
- $11 million allotted for the SD program—July 1, 2010 until December 31, 2014.
- South Dakota contracted with U.S. Department of Health and Human Services to run the local program.
- Federal High Risk Pool information (application, rates, plan document, etc.) available by calling 605.773.3148.
- Have been without health care coverage for the last six months.
- Have a preexisting medical condition shown by one of the following:
- Denial of coverage letter from a major insurance carrier.
- An acceptance letter for health coverage with a disease or condition rider.
- Medical documentation of a qualified health condition as listed on application or website.
- Be a South Dakota resident.
- Be a U.S. citizen or lawfully present in the United States.
- Premiums are similar to the South Dakota individual private insurance market.
- $2,000 deductible plan:
- Pharmacy coverage begins on day one, three- tier copay structure.
- Preventive services not subject to deductible or coinsurance requirements.
- Max out-of-pocket $5,750 ($4,250 medical and $1,500 pharmacy).
- Plan year July 1—June 30.
- Dakotacare Provider Network.
- Eligible individuals can apply on their own or use a licensed insurance agent.
- Agents will earn a 3% commission.
- Enrollment may be capped due to limited federal funds.
- Separate program from the South Dakota Risk Pool.
- SD Bureau of Human Resources administers both programs.
- Rates and network are different for the programs.
- Eligibility criteria different for the programs.
- No plans to change current SD Risk Pool program.
- Both programs will terminate in 2014 pursuant to PPACA.
See a related press release on the state of South Dakota News Web
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