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Iowa Health Insurance

Health insurance is an important precaution when it comes to insuring your financial future. Protecting your family against the occurrence of illness or injury is rather difficult; however a suitable health policy can relieve your financial burden caused by these events. When it comes to purchasing health coverage, you should evaluate all potential risks and its effect on your finances. In the U.S., approximately 47 million people are uninsured, majority of whom are working families. These families, especially children, end up bearing the consequences of not having proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to these individuals.

Iowa is the 15th healthiest state to live in and obtain health coverage, according to the America's Health 2008 Rankings. The state has not shown much improvement in its healthcare system since last two years; it was on 14th and 11th position in 2007 and 2006 respectively. The main cause for the stagnant healthcare is the low public health funding. The state of Iowa, with more than two million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-priced coverage to the uninsurable residents of Iowa who meet specific eligibility requirements of age and income.

The Iowa Insurance Division manages and supervises all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s strong health features, approximately 9.9% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 39.1% of Iowa’s uninsured residents come under the above 200% FPL category.

Buying health coverage is not easy; however, with the help of a licensed health insurance agent/broker, you can choose a proper health insurance plan with benefits that are ideal for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Iowa. These regulations apply to all insurance companies offering individual or c:

Medical Underwriting

Yes

Pre-Existing Condition Exclusion Period

24 months

Look Back Period

60 months

Look Back Standard

Prudent person

Mandatory Benefits

Cancer screening for women including breast cancer screening, OB/GYNs are Primary Care Providers

Market Rate Restrictions

Yes

Guaranteed Issue Options

None

Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Iowa. These regulations apply to all insurance companies offering small group health insurance in Iowa.

Small Group Size

2-50

Employee Qualifications

Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week

Guaranteed Issue

Yes

Premium Rating Factors

Rate Bands

Rate Adjustment Factors

25%

Look-Back Period

6 months

Pre-existing condition exclusionary period

12 months

Mandatory Benefits

Same as individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Iowa. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option

Yes

Eligible Group Sizes

2-19

Extension of Benefits Period - Standard

9 months

Extension of Benefits Period - Disabled

9 months

Maximum Premium Increase

100%

State Legislation Reference

Iowa Insurance Code 509 B.3, Section

Additional Notes

The election period is 30 days following the termination date of employment and any individual that is eligible for coverage under a different group health insur­ance policy is not eligible.

State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Iowa to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Iowa is summarized in the chart below:

Plan Name

Health Insurance Plan of IOWA (HIPIOWA)

Website

http://www.hipiowa.com/

Phone Number

877- 793-6880

HIPPA Eligibility Required?

Yes

Available Carriers

Midlands Choice Provider Network

Pre-Existing Condition Waiting Period

6 months

Enrollment Periods

Open to new enrollment

Premium Limits

No more than I50% of standard rates

Lifetime Maximum Benefit

$3 million

Special Notes

HIPIOWA Plans also cover ‘HIPAA eligible individuals’ who have left group health coverage and fully exhausted all COBRA or state continuation coverage for which they are eligible.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Iowa provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

Healthy and Well Kids in Iowa (HAWK-I)

Website

http://www.hawk-i.org/en_US/index.html

Phone Number

800-257-8563

Apply Online

Yes

Age Limits

Under 19

Insurance Carrier

Wellmark Classic Blue Health and Dental, AmeriChoice, a plan from UnitedHealthcare Plan, Wellmark Health Plan of Iowa Blue Access and Blue Dental and Delta Dental.

Length of Coverage

12 months

Residency Requirements

Iowa resident and U.S. citizen, qualified alien

Other Eligibility Requirements

Children that are dependents of a state of Iowa employee or children that are eligible for Medicaid are not eligible for coverage under the hawk-i program.

Pre-Existing Condition Exclusions

None

Cost

No cost or minimal share of cost. Family pays no more than $20.

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Iowa:

Governing Agency

Iowa Department of Human Services

Website

http://www.ime.state.ia.us/Members/

Phone Number

800-338-8366

Residency Requirements

Iowa resident and U.S. citizen

Federal Poverty Line Income Limits

Children (ages 1-19): 133% FPL
Pregnant Women and Infants (ages 0-1): 200% FPL
Working Parents: 82% FPL
Non-Working Parents: 33% FPL
Supplemental Security Income Recipients: 74% FPL
Medically Needy Individual: 67% FPL
Medically Needy Couple: 50% FPL

Additional Resources

Iowa Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Iowa’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Iowa: At-A-Glance

Provides exclusive health data of Iowa. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.


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