Non-Group Coverage Rules for HIPAA Eligible Individuals

2012

Location	State HIPAA Approach	Qualifications?	Insurer?	Are There Limits on What Can be Charged?	Are There Minimum Standards for What Must be Covered?
United States	N/A	N/A	N/A	N/A	N/A
Alabama	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Alaska	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Arizona	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
Arkansas	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
California	Federal Fallback	HIPAA eligible	All individual market carriers	Yes	No
Colorado	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Connecticut	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Delaware	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
District of Columbia	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
Florida	Alternative Mechanism	HIPAA eligible	Prior group carrier or Federal Fallback	Yes for prior group carrier; No for Federal Fallback	Yes, prior group carrier; No, Federal Fallback
Georgia	Alternative Mechanism	HIPAA eligible	Prior group carrier or assigned individual market carriers	Yes	Yes
Hawaii	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
Idaho	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
Illinois	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Indiana	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Iowa	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Kansas	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Kentucky	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Louisiana	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Maine	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
Maryland	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Massachusetts	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
Michigan	Alternative Mechanism	HIPAA eligible	Blue Cross Blue Shield	Yes	No
Minnesota	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Mississippi	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Missouri	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Montana	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Nebraska	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Nevada	Federal Fallback	HIPAA eligible	All individual market carriers	Yes	Yes
New Hampshire	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
New Jersey	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
New Mexico	Alternative Mechanism	HIPAA eligible	High Risk Pool or New Mexico Health Insurance Alliance	Yes	Yes
New York	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
North Carolina	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
North Dakota	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Ohio	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
Oklahoma	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Oregon	Alternative Mechanism	HIPAA eligible	All individual market carriers or High Risk Pool	Yes	Yes
Pennsylvania	Alternative Mechanism	HIPAA eligible	Blue Cross Blue Shield plans	Yes	No
Rhode Island	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
South Carolina	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
South Dakota	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Tennessee	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
Texas	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Utah	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Vermont	Alternative Mechanism	HIPAA eligible	All individual market carriers	Yes	Yes
Virginia	Federal Fallback	HIPAA eligible	All individual market carriers	No	No
Washington	Alternative Mechanism	HIPAA eligible	All individual carriers or High Risk Pool	Yes	Yes
West Virginia	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Wisconsin	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes
Wyoming	Alternative Mechanism	HIPAA eligible	High Risk Pool	Yes	Yes

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Non-Group Coverage Rules for HIPAA Eligible Individuals

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Non-Group Coverage Rules for HIPAA Eligible Individuals

2012

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