Modifying Existing High Risk Pool Statutes to Allow Eligibility for TAA

Most statutes have to be modified in three to four places:

Under definition of resident add:
or, an individual who is legally domiciled in (name of state) on the date of application to the pool and is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code of 1986.

Under basic eligibility add:
or, an individual who is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code of 1986.

In addition, in the eligibility section, most states further define eligible individuals as those who do not have other group options or COBRA available. Qualified TAA eligibles (with qualified prior coverage) do not have to exhaust COBRA. Most existing statutes would be amended as follows:

A person is not eligible for coverage from the plan if the person;
(1) is eligible for other health care benefits at the time application is made to the plan, including COBRA continuation except;
(A) if the individual is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code of 1986, and has three months of prior creditable coverage as described in(cite reference in preexisting conditions section), the requirement for exhaustion of any available COBRA or state continuation benefits is waived.

Under pre-existing conditions section, add:
In the case of an individual who is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code of 1986, the pre-existing conditions limitation will not apply only if the individual maintained creditable health insurance coverage for an aggregate period of three months as of the date on which the individual seeks to enroll in pool coverage, not counting any period prior to a 63-day break in coverage.

For questions contact Janet Trautwein, jtrautwein@nahu.org, (703) 276-3806

Content copyright © 1998-2008 National Association of Health Underwriters. All rights reserved.
National Association of Health Underwriters · 2000 North 14th Street, Suite 450 · Arlington, VA 22201
703.276.0220 · fax 703.841.7797 · info@nahu.org