Health reform payoff

Todd Dills | August 01, 2010

Have you been denied health coverage because of an existing or past medical condition?

To get coverage, first see if you live in one of 31 states (plus the District of Columbia) that are administering the new national high-risk pool (HRP) under the Pre-Existing Condition Insurance Plan name. A full list, including contact information, of most relevant state departments is available at Click link under “Member States.” Otherwise, look up your state’s health services department for info or utilize the site to steer you toward the right contact.



1. Call for application information. Some states have waiting lists for their state HRPs, but the new national HRP should be open to new applicants.

2. Be sure to request information on both national and state HRPs, such as they exist. The national pool may represent a more affordable option than your state’s original pool, as long you meet its requirements.



1. Visit the U.S. Department of Health and Human Services website for the Pre-Existing Condition Insurance Plan,, for information on joining the national pool.

2. Be prepared to provide proof of the following to obtain coverage in the national HRP:

• That you have been without creditable health insurance coverage for the last six months.

• That you are a citizen or legal resident of the United States.

• That you have been denied health insurance due to a pre-existing condition or something else in your medical history.

ANNUAL SPENDING CAPS: For those enrolled in the national high-risk pool, out-of-pocket spending limits for 2010 are $5,950 for individuals, $11,900 for families. Compare these figures to the average yearly premium costs alone ($5,820) for enrollees in existing state high-risk pools. If your state has its own HRP and you qualify for both it and the national pool, compare key features, such as monthly premium, level of coverage, deductibles and provider network.

States administering the national HRP

Application to the new national high-risk pool should be made through the U.S. Department of Health and Human Services (visit unless you live in the District of Columbia or one of these states: Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia, Wisconsin. To access your state’s plan administrators, visit n strives to maintain an open forum for reader opinions. Click here to read our comment policy.