The Missouri Health Insurance Pool is a comprehensive health plan for those who have been rejected by a private health insurer. Created in 1991, MHIP is a nonprofit organization catering to uninsured Missouri residents who cannot obtain coverage due to their medical condition, COBRA benefits ending, or other factors. Since the introduction of the Affordable Care Act in 2010, there have been two pools: one run by the state, and one operated on the federal level. Eligibility varies between the two programs. Though the organization may not be an insurer, MHIP works like a private insurance company, supervised by the Missouri Department of Insurance, and following state insurance regulations.
MHIP State Pool
The state pool is open to those who are legal Missouri residents, and have documentation of any of the following:
- Decline from an insurer for coverage similar to MHIP due to your health
- Rate increase for coverage similar to MHIP at a premium over the MHIP amount
- Federally define eligible individual who has not has a significant gap in coverage
- A resident dependent of someone eligible for MHIP
- Trade act eligible individual
- Dependents of a trade act individual as claimed on their tax form
- Health insurance was canceled involuntarily for any reason other than fraud or nonpayment of premiums
- Health insurance with a premium 150-200% of the individual standard rate
- Currently insured and would have qualified as a federally defined eligible or trade act eligible between effective dates of HIPPA
State Pool Plans
Five plans give residents the same benefit options at varying cost levels. Each provides doctor’s office visits, major medical care such as surgery and hospital stays, and prescriptions. Preventive care is also covered. All the services you would expect from a comprehensive individual health insurance plan are provided by MHIP, which uses a PPO network. Members can choose to seek care in or out of the network, and coverage is also available for conditions, if applicable.
State Pool Premiums
MHIP’s state pool requires all members to pay a premium, which varies based on your age and gender, and the plan you select. Premiums can be either monthly or quarterly, and they are required by law to exist in a range between 125 and 200 percent of the average rates charged for similar health insurance plans from the five main insurers on the individual market in Missouri. The state pool provides five plan options to Missouri residents, all of which have a full range of medical care and prescription coverage. Benefits remain the same though there are different deductibles and out-of-pocket maximums.
MHIP Pre-Existing Condition Insurance Plan
The federal high risk pool is open to Missouri residents who have been uninsured for at least six months and have been declined by an individual health insurance company because of their health. If you have been rejected for coverage due to a pre-existing condition, this may be the right source of coverage. In order to qualify, you must also be a U.S. citizen or legal resident. Proof must be provided to indicate the length of time you have been without creditable coverage, as well as documentation of your medical condition from a doctor or rejection letter from an insurer.
MHIP PCIP Plans
The federal high risk pool, or PCIP, in Missouri has three plan options with varying deductibles. Each plan covers 80 percent of your major medical care after you reach the deductible, and offers prescriptions for a copay. Like the MHIP state plans, members have the option of using both in-network and out-of-network providers for care. There is no option for opening a health savings account with any of these plans.
MHIP PCIP Premiums
Premiums for PCIP vary only based on age, as they cannot change for gender or health status. The Affordable Care Act has created this high-risk pool as a preview of the nondiscrimination people will experience in 2014 when all insurers are required to provide coverage to people with conditions. Rates will also increase in the beginning of 2013, as indicated below.
How to Apply for MHIP
If you have assessed your eligibility for the MHIP state or federal pool and feel that you qualify, you may apply for the plan of your choice by downloading the form and mailing it to the MHIP office. After you choose a plan and are aware of your premium, you may fill out the application and include all necessary documents requested by the program. This may include doctor’s notes if you have a condition, letters of rejection, or any corresponding evidence to prove your eligibility.
832 Weathered Rock Court
PO Box 104538
Jefferson City, MO 65110-4538
1. Missouri Health Insurance Pool. “Missouri Health Insurance Pool”. http://www.mhip.org.