High Risk Pools (HRP)

1. High Risk Pools (HRP) 2011

2. Agenda • Background • Federal Medical Insurance Pool (FMIP) • Oregon Medical Insurance Pool (OMIP) • Eligibility • Administration • Funding & Rates • Benefit Plans & Pre-existing Conditions • Family Health Insurance Assistance Program (FHIAP)

3. Program Intent 1984 Dave Houck ORS 735.600 Provide access to residents denied adequate medical insurance Avoid undue financial impact on State Private insurers

4. OMIP Background Enacted in 1987 by Oregon Legislature First policy issued in July 1990 Enrollment as of January 2011 13,774 people insured 85% medically eligible 15% portability eligible Over 60,000 people served since inception

5. FMIP Eligibility Medical Individual with a pre-existing medical condition Physician’s signature Uninsured for six months US citizen or lawfully present If they meet eligibility must enroll in FMIP Cannot enroll in OMIP 1,500 deduction plan Exceptions may be granted Separate prescription deductible

6. OMIP Medical • Medical • Individual health insurance company declination • One or more listed medical conditions • Within last five years • Insurance carrier consensus • Physician’s signature • Due to medical condition offered health coverage • With a restrictive waiver • With limited plan choice

7. OMIP Portability • Portability • Exhausted COBRA/State Continuation & no Oregon Portability available with previous carrier • No COBRA/State Continuation or Portability available with previous plan • 180 consecutive days of group coverage or at least 18 months of creditable coverage without a gap in coverage greater than 63 days with the most recent ending in group

8. OMIP Portability (cont.) • Portability • Covered by Portability but insurance carrier no longer serves area • Moving to Oregon • Been continuously covered for 18 or more months • No single gap in coverage greater than 63 days • Last coverage was group

9. OMIP Funding • Sources(no state/federal funds) • Member Premiums • Currently 50 percent • Insurance company assessments • Currently 50 percent

10. FMIP Funding Sources Member Premiums Federal Funding $66 million total allocation for Oregon

11. OMIP Premium Rates • Medically eligible - can be as much as 25 percent higher than individual market rates • 10% currently • Portability eligible - same as portability market rates

12. FMIP Premium Rates Equal to average market rate for comparable benefit plan Subject to HHS review

13. Benefit Plans • OMIP has four PPO benefit plans • Plan 500: 20/40 PPO $1,500 out-of-pocket max* • Plan 750: 20/40 PPO $3,750 out-of-pocket max* • Plan 1000: 20/40 PPO $5,000 out-of-pocket max* • Plan 1500: 30/50 PPO $8,500 out-of-pocket max* • no out-of-pocket max on prescription drugs • FMIP has plan 500 & 750 • Plan 500: 20/40 PPO $5,950 total out-of-pocket max • Plan 750: 20/40 PPO $5,950 total out-of-pocket max

14. Benefit Differences

15. Questions? For more informationabout OMIP or updated information about FMIP, please view our Web site: www.OMIP.state.or.us Or Email us at: OMIP.Mail@state.or.us

16. Family Health InsuranceAssistance Program

17. FHIAP Family Health Insurance Assistance Program Subsidy program NOT an insurance plan Pays between 50 & 95 percent of health insurance premiums 100 percent for kids 18 and younger 12-month subsidy period – renewable FHIAP may pay dental and vision premiums

18. FHIAP: Eligibility • Uninsured for past 2 months or leaving OHP • Oregon resident • U.S citizen/qualified non-citizen • No asset test • Not eligible for or receiving Medicare • Insurance plan meets FHIAP benchmark • Meet income guidelines

19. FHIAP: Update • Exceptions to POU • Newly unemployed and lost health insurance • COBRA • Exhausted COBRA enrolled into prevailing plan • Lost coverage - reduction in hours • Full-time to part-time • Employer dropped coverage • Leaving Oregon Health Plan (OHP)

20. FHIAP: Update • Group market open • Applications on-line • Individual market • Pre-qualification (parking lot) • Application wizard • http://oregon.gov/OPHP/fhiapwizard.shtml

21. FHIAP: Reservation List • Reservation list by • Self • Other person • www.fhiap.oregon.gov 888-564-9669

22. OMIP/FMIP & FHIAP Billing • Member receives bill from FHIAP • For member portion of premium • Member submits premium portion to FHIAP • FHIAP member payment is combined • FHIAP pays full premium to Regence • Cannot pay Regence until member pays

23. FHIAP: Contacts Website: www.fhiap.oregon.gov E-mail: ophp.mail@state.or.us Phone: 888-564-9669

24. OMIP/FMIP & FHIAP FAQs • I can’t afford my premium can FHIAP help? • FHIAP helps uninsured Oregonians • Uninsured two months or more • Some exceptions • What about when there are FHIAP openings? • Average 45 days to process applications • Can I get FHIAP help sooner because of my medical condition? • FHIAP operates first come, first serve

25. OMIP/FMIP & FHIAP FAQs • What if I have to drop my OMIP/FMIP? • OMIP • Cannot re-enroll in OMIP for one year • May be able to enroll in FMIP in six months • If FMIP enrollment is not capped • If FMIP criteria is met • FMIP • Cannot re-enroll in FMIP for six months • Can enroll in OMIP right away • If OMIP criteria is met

26. OMIP/FMIP & FHIAP FAQs • What if I have to drop my OMIP/FMIP? (cont.) • FHIAP individual coverage reservation list • Projected wait 18 months to two years

27. OMIP/FMIP & FHIAP FAQs • Why aren’t my claims being paid? • FHIAP cannot pay Regence until member pays • I qualify for Medicare who do I notify? • OMIP/FMIP • FHIAP

28. Thank You!