Your Rights under Alaska Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
In Alaska, your options for health insurance are somewhat dependent on your health status. It cannot be canceled just because you get sick. Most health insurance is guaranteed renewable.
The Alaska Medicaid program offers free health coverage for pregnant women, families with children elderly and disabled individuals with very low incomes. Denali KidCare, part of Alaska’s Medicare program, offers free or subsidized health coverage for children who are uninsured and pregnant women.
Poor elderly or disabled people who get Supplemental Security Income benefits are eligible for Medicaid. Retired or disabled people who have low incomes and are enrolled in Medicare may also qualify for help from Medicaid.
The Breast and Cervical Cancer Health Check Program provides free cancer screening for qualified residents. Women of Alaska diagnosed with breast or cervical cancer through this program may be eligible for medical care through Medicaid.
If you are HIPAA eligible, Alaska Comprehensive Health Insurance Association (ACHIA) is your only guaranteed access to individual health insurance though you may be able to purchase health insurance through other insurance companies. In most cases, the law does not limit what you can be charged for health insurance.
ACHIA is a high risk pool program that offers insurance for people with health conditions who are unable to buy private health insurance coverage.
In Alaska, you must apply within 90 days to receive ACHIA coverage without a pre-existing condition exclusion period. Its coverage includes hospital and physician care, diagnostic tests and x-rays, prescription drugs, and other services. It will pay for 80% of covered charges after you have satisfied your annual deductible.
If you move away from Alaska, you may not be able to buy individual health insurance in another state unless you are HIPAA eligible.
Under Alaska law, newborns, adopted children, and children placed for adoption are automatically covered under the parents’ individual health insurance policy for the first 31 days, it the policy covers dependents. Similarly, new spouses can be covered beginning on the 1st day of the 1st month after the date the health plan receives the enrollment request. The may be required of the insurer that the enrollment request be received with 31 days of the marriage date or order for coverage to be effective.
There is no standard definition for pre-existing condition for the individual market under Alaska law; however, typically a health plan with define a pre-existing condition exclusion to include both conditions that you actually received care for. It includes as well as conditions or symptoms for which the insurer believes most people in your situation would have sought to care. It is called the prudent person rule.
For more information about Individual health insurance, visit the Alaska Division of Insurance website at http://www.dced.state.ak.us/insurance
Group Health Insurance:
If you lose your group health insurance and meet other qualifications, you will be HIPAA eligible. You can buy an individual health insurance policy from the ACHIA. You will not have a pre-existing condition exclusion period. There are limits on what you can be charged for an ACHIA policy.
You may also be able to buy insurance from ACHIA if you have had difficulty obtaining affordable health insurance from private companies because of current health conditions. You may face a new pre-existing condition exclusion.
If you are joining a new group health plan that is self funded ,you may have to satisfy a new pre-existing condition period if you have a break in coverage of 2 or more months. When joining a new group health plan that is fully funded, you may have to satisfy a new pre-existing condition period if you have a break in coverage of 3 or more months.
Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns, newly adopted children, children placed for adoption, or genetic information.
If you are a small employer in Alaska, insurance companies initially must offer coverage to all of your eligible employees. If you decide not to offer health benefits to all "eligible employees," insurers must initially offer you a small group health plan that would cover all of your eligible employees. Remember that you may not condition eligibility for health benefits on the health status of your employees or their dependents to decide who receives coverage, but you may use other factors such as part-time employment.
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