Immediate Access to Insurance for Uninsured Individuals with a Preexisting Condition – Section 1101 (Temporary High Risk Pool)

(a) IN GENERAL.-Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.
This provision establishes that through a state or a nonprofit entity a high risk pool must be made available to individuals. The high risk pools must provide insurance to all eligible individuals that:

  • Does not impose any preexisting condition exclusion;
  • Provides health insurance that the issuer’s share of the costs may not be less than 65% of cost of care;  
  • Has an out of pocket limit

 To qualify for the high risk pool, you must:

  • Be a legal citizen or national of the United States
  • Have not been covered under a credible plan in the previous 6 months before applying through the pool
  • Have a preexisting condition, as defined by guidance issued by the SecretaryHHS Secretary

What does this mean for the bleeding disorders community?
The high risk pool should be made available no later than 90 days from March 23, 2010, the date of enactment of Public Law 111-148. This law requires creation of a pool set up by each state or a non-profit entity which will be available to people who have been uninsured for at least 6 months.  It will differ from state to state so it is important to learn and understand how your state is implementing this new requirement.