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Healthcare reform offers new risk pool

JACKSON — An uninsured Mississippian diagnosed with cancer can now obtain healthcare coverage and start filing claims for treatment almost immediately.

That is how a new program offered by the healthcare reform bill will work, says Lanny Craft, executive director of the separate and already existing Mississippi Comprehensive Health Insurance Risk Pool Association.

The new risk pool, created by the federal healthcare legislation, went into effect July 1 in Mississippi. People can sign up now and start receiving benefits by Aug. 1, according to information provided by the Mississippi Department of Insurance.

To be eligible, a person must have been turned down by a private insurance company because of a pre-existing condition and must have been without any type of insurance private coverage such as an employer-sponsored program, or a government program, such as Medicaid for six months.

“The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage,” said Mississippi Commissioner of Insurance Mike Chaney. “Part of the federal government’s plan to reform health care in our country centers around those with pre-existing medical conditions that may have prevented them from being able to find health insurance.”

The federal healthcare legislation will not be fully phased in until 2014. But various parts of the legislation will take effect earlier, such as the provision that allows people to sign up for the risk pool if they cannot obtain insurance to treat pre-existing conditions.

The exact cost of the plan is yet to be determined, but people are not supposed to pay any more than healthy people currently pay. Federal law states people are not supposed to pay more than $5,950 per year for the coverage.

Many states, including Mississippi, already operate high-risk pools for people who have trouble finding insurance on the open market.

The premiums for the health insurance through the existing state pools might be more than some people can afford, according to various published reports.

And in some cases, the existing state program might not provide coverage.

Craft said in some instances the existing Mississippi high-risk pool might be a better choice for a person to obtain coverage, but in other instances the federal program would make more sense.

While the Risk Pool Association office does not administer the federal program, Craft said his office would help people determine the better option. Craft stressed that Mississippi would continue to operate its high-risk pool, which has been in existence for years.

Mississippi is one of about 20 states that opted not to administer the new program set up by the federal law. In states that don’t choose to operate the program, the U.S. Department of Health and Human Services will administer it.

In an earlier interview, Dan Turner, a spokesman for Gov. Haley Barbour, said one reason the state chose not to operate the new high-risk pool by itself is that many experts believe that the $5 billion put in the program by Congress will not be enough to run it until 2014, when it will be replaced by exchanges that prevent insurance companies from denying coverage for pre-existing conditions.

Turner said between 4,000 and 5,000 Mississippians would qualify for coverage through the high-risk pools, but that funds would be available to cover no more than half of those eligible.

Turner said those figures could change based on the number of people who actually enroll and the claims those people make.

Craft and Chaney said one advantage to allowing the federal government to administer the program is that Mississippians can get in the new program quicker.

While people can already sign up for coverage in those 20 states that opted to allow the federal government to administer the program, many of the other states are still working to set up the plans they will operate.

Craft said he does not have numbers yet on how many people in Mississippi are signing up, but said his office has had numerous inquiries.


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