High-Risk Insurance

What Do State High-Risk Insurance Pools Provide?

State high risk insurance pools may help children (including teenage children) with arthritis and other conditions who, because of their medical condition, have been denied individual health coverage or cannot get it at a reasonable cost. They provide an insurance alternative that can be purchased by the child’s family at a more reasonable monthly rate than a private, individual policy. They may provide a lower cost health insurance option to children with juvenile arthritis (JA) who do not qualify for Medicaid or S-CHIP and need to purchase an individual policy.

Many insurance pools are managed care plans. They provide coverage of a wide range of health care services, including inpatient and outpatient hospital services, physician services, therapies (including physical therapy), and medications. There is generally a lifetime maximum benefit per person that the insurance plan will pay (for example, $1 million.).

As with other insurance plans, there may be a waiting period for coverage of pre-existing conditions. These are medical conditions that the person applying for coverage already has. Waiting periods for pre-existing conditions, however, may be waived or shortened, depending on the circumstances of a particular case. Be sure to ask about any waiting period for pre-existing conditions.