HIP Utah Description
In 1991, the state established the Utah
Comprehensive Health Insurance Pool
(HIPUtah) to specifically address the
problem of people with serious medical
conditions, such as cancer, diabetes,
heart disease, and other chronic
illnesses, that made them unable to
obtain health insurance at any price.
HIPUtah also serves as the state's
Health Insurance Portability and
Accountability Act (HIPAA) alternative,
which is required by Federal Legislation
to protect the individual market from
extra costs of uninsurable individuals
entering from group coverage. HIPUtah is
funded by a combination of enrollee
premiums and yearly legislative
appropriations. HIPUtah's mission is to
provide a health insurance program for
uninsurable individuals that provides
access to quality healthcare and is to
be administered on a fiscally sound
basis.
The state of Utah
contracted with SelectHealth to
administer HIPUtah effective July 1,
2005. Coverage in HIPUtah is not
guaranteed. Each application is
carefully reviewed to assure that all
eligibility requirements are met. If an
applicant is eligible for coverage in
the private market, the applicant is not
eligible for HIPUtah unless the
applicant is HIPAA eligible.
How to Apply for Coverage
To apply for HIPUtah coverage, you must
follow these steps
- Print out the HIPUtah
Application and complete it in ink
(online submission is not yet
available). Please pay special
attention to the instructions and
provide the necessary information
requested. If the application is not
complete or if the required
documentation is missing, the
application will be returned to you
and will delay the application
process and your effective date
HIP Utah Application
-
URGENT: Most people
forget to include the following! Include copies of your
medical
records or a physician's letter
detailing your diagnoses and
prognoses with your application. In
addition, to receive credit for
prior insurance coverage, you must
submit proof of previous insurance.
You must also include proof or
Citizenship and/or residency. Send
this info with your application!
- Choose a deductible and premium.
There are four calendar year
deductible options available. The
HIPUtah Outline of Coverage includes
information on these. Choose the
specific deductible desired and
determine the monthly rate
(premiums) for the deductible you
have selected
HIPUtah Outline of Coverage
HIPUtah Premiums
HIP Utah Benefits
- When all forms are completed,
mail the application, the medical
information, proof of insurance, and
payment option to the following
address:
Fax to :
(801) 386-5499
Mail to:
Greg Davies
IBP of Utah
P.O. Box 95210
South Jordan, UT 84095
If the application is complete and
all documentation is provided, you can
expect to receive a status report from a
HIP Utah representative within two weeks
of the submission of your application.
If additional medical information or
other information is required, we will
contact you.
See Rates
Get Application
Outline of Coverage
See Benefits
Exclusion Periods
A medical condition that was
present before the effective date of
coverage, whether or not any medical advice,
diagnosis, care, or treatment was
recommended or received before that day,
known as a Pre-Existing Condition, will not
be covered by HIPUtah for the first six
months following the effective date of
coverage except in the following instances
when a person is:
- HIPAA eligible; or
- Transferring from an
out-of-state high risk pool within
established time regulations; or
- Involuntarily
terminated from either individual or
group coverage and has no other option
for coverage.
HIPUtah will not cover
services for a pre-existing pregnancy for
the first ten months following the effective
date of coverage, unless the enrollee is
HIPAA eligible.
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Who is Eligible?
See Eligibility PDF
A person
is eligible for HIP Utah coverage if the following criteria
is met:
- Has resided in Utah
for 12 consecutive months immediately
preceding the date of application for
HIP Utah (the 12-month requirement can be
waived if coming from another state's
high risk pool);
- Pays the established
premium;
- Meets the required
health underwriting criteria established
by the state of Utah; and
- Does not fall into
the ineligible categories listed later
in this outline
OR
- Pays the established
premium;
- Is HIPAA eligible and
has at least 18 months of prior
coverage, the most recent prior coverage
being under a group health plan,
government plan, or church plan, and has
elected and exhausted COBRA or a state
continuation plan where available;
- Applies for HIP Utah
coverage within 63 days of termination
from prior coverage; and
- Does not fall into
the ineligible categories listed later
in this outline.
Who is NOT Eligible?
A person is NOT eligible for
HIP Utah coverage if any one of the following
is true:
- The person is
eligible for benefits under Medicaid or
Medicare except as provided in Utah Code
Ann. -31A-29-112;
- HIPUtah coverage has
been terminated within the last 12
months unless the person demonstrates
that continuous other coverage has been
involuntarily terminated for any reason
other than non-payment of premium,
unless the person is HIPAA eligible;
- The person has
exhausted the maximum lifetime benefits
of HIPUtah;
- The person is an
inmate of a public institution;
- The person is
eligible for a public health plan
through which medical care is provided;
- The person is
eligible for a group health benefit
through an employer plan;
- The person is covered
under any other health benefit plan;
- The person's health
condition does not meet the health
underwriting criteria established by the
state of Utah, unless the person is
HIPAA eligible; or
- The person has not
resided in Utah for 12 consecutive
months, unless HIPAA eligible.
- The person's employer
pays any part of the individual's health
benefit plan premium, either as an
insured or a dependent, for pool
coverage.
Are You HIPAA Eligible?
Under a federal law known as
HIPAA, which stands for the Health Insurance
Portability and Accountability Act, if you
are an eligible individual, who has recently
lost their employer or union sponsored group
health plan you have a right to purchase
individual health coverage through HIPUtah,
the state of Utah's high-risk pool, without
a preexisting condition exclusion.
In order to be HIPAA
eligible, all of the following must apply:
- Your last health care
coverage must have been under a group
plan, governmental plan, or church plan,
including COBRA or state continuation
coverage, for an aggregate of at least
18 months during which there is no break
of 63 or more complete days in a row.
This prior health coverage is referred
to as "creditable coverage."
- You are not eligible
under a group health plan, Medicare,
Medicaid, and/or do not have other
health insurance coverage.
- You did not lose your
latest health coverage due to nonpayment
of premium or fraud.
- If you qualify for
COBRA or state continuation coverage,
you must accept the coverage and
continue the coverage for the maximum
time period allowed. (When an employer
terminates its group health plan
entirely, COBRA coverage ends and is
considered exhausted.)
Once COBRA or state
continuation coverage has been exhausted,
you have 63 days to file an application to
get a policy through HIPUtah as a HIPAA
eligible individual. If you accept a
conversion policy or a short-term policy
after exhausting COBRA, you give up your
HIPAA eligibility. It is important to know
that a conversion policy is not a HIPAA
policy.
When applying for the
high-risk pool you can present a Certificate
of Creditable Coverage from your insurance
company or health plan showing that you have
an aggregate of 18 months of creditable
coverage as part of applying for coverage
under HIPUtah. If a Certificate of
Creditable Coverage is not available, you
may document your prior health coverage by
other means, including by telephone.
Just Remember, if you are
interested in obtaining individual coverage
and you meet the other criteria to be an
eligible individual, you should apply for
this coverage as soon as possible to avoid
losing your eligible individual status due
to a 63-day break.
See Rates
Get Application
Outline of Coverage
See Benefits
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