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GENERAL ELIGIBILITY REQUIREMENTS
Coverage is available to persons who meet the following general requirements:
- Kansas Health Insurance Association (KHIA) in conjunction with the State of Kansas offers a plan to provide health care benefits for Kansas residents who are unable to purchase health insurance or obtain coverage for an existing medical condition,
who have exhausted their health insurance benefits, who have been quoted insurance rates more than the KHIA rate, or otherwise qualify under the Health Insurance Portability and Accountability Act (HIPAA).
- Coverage is available for individuals only.
- Four plan deductibles are available. See Plan Comparisons and Premium Rates for more information.
- The KHIA program is available to individuals who are residents of Kansas at the time of application and who remain residents of Kansas. Eligibility requirements vary according to the basis upon which application is made.
MEDICAL CONDITION ELIGIBILITY
Eligibility based on a Medical Condition, current premium rate or involuntary termination of an individual health policy. (requires 6 months of residency)
- Applicants must have applied for health insurance and been rejected by two carriers because of a health condition; or
- Applicant must have been quoted a rate more than the KHIA rate; or
- Applicant must have been accepted for health insurance subject to an exclusion of a pre-existing disease or condition; or
- Applicant must have had previous individual insurance coverage involuntarily terminated for a reason other than non-payment of premiums; and
- Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any successor program, and does not have other health insurance coverage.
Documentation required for medical condition.
One of the following documents showing your name and address to prove your Kansas residency must be submitted with the KHIA application for all applicants.
Must be at least 6 months old prior to making your application.
Kansas Driver's License; or
Most recent Kansas tax return; or
Six-month-old utility bill showing current Kansas address; or
Six-month-old cancelled check showing current Kansas address
Applicants must also provide the following documentation to prove eligibility.
If you have been rejected for health care coverage by at least two insurance carriers, include a letter or form from authorized representatives of two Kansas-licensed health insurers or health plans documenting the underwriting action taken. This documentation must indicate that coverage was refused; or
If you are being charged more than the KHIA Plan's rates for individual health care coverage, include the premium bill from your insurer; or
If you have been accepted for health insurance coverage but are subject to an exclusion of a pre-existing condition or disease, include the policy form that indicates the exclusion of coverage for specific conditions; or
If your individual health insurance has been involuntarily terminated for any other reason than non-payment of premiums, please include the letter from the insurance company stating termination.
Applicants are subject to a 90-day pre-existing condition exclusion if there is a lapse in coverage of more than 31 days prior to their enrollment in KHIA.
FEDERALLY DEFINED ELIGIBILITY (no length of residency required)
- Applicant, as of the date on which the individual seeks coverage under this Plan, has aggregate creditable coverage of 18 months or more;
- Applicant's most recent prior creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan;
- Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any successor program, and does not have other health insurance coverage;
- Applicant's most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;
- Applicant, if offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, elected such coverage; and
- Applicant has exhausted such continuation coverage under such provision or program, if the applicant elected the continuation coverage.
Documentation required for federally defined eligibility.
Applicants seeking coverage based on federally defined eligibility must provide one of the following documents to prove eligibility.
- A certificate of creditable coverage from all previous insurers, the aggregate of which is 18 months.
- If Applicant's most recent coverage within the period of aggregate creditable coverage was terminated for reasons other than non-payment of premiums or fraud, attach a certification of canceled coverage indicating the termination reason and termination date.
Applications must be received within 63 days of the termination date of other insurance or applicant will not be eligible for coverage based on federally defined eligibility. Rather they must meet medical condition criteria. (see medical condition). In such cases, 6-month residency is required and pre-existing condition exclusions will be applied for 90 days.
FEDERALLY DEFINED ELIGIBILITY for FTAA (no length of residency required)
- Applicant, as of the date on which the individual seeks coverage under this Plan, has aggregate creditable coverage of 18 months or more;
- Applicant's most recent prior creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan;
- Applicant is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act (Medicare) or a State plan under Title XIX of such act (Medicaid) or any successor program, and does not have other health insurance coverage;
- Applicant's most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;
- Applicant, if offered the option of continuation coverage under a COBRA continuation provision or under a similar State program, elected such coverage; and
- Applicant has exhausted such continuation coverage under such provision or program, if the applicant elected the continuation coverage.
- Applicant must be eligible for the credit for health insurance costs under section 35 of the internal revenue code of 1986.
- “FTAA” means federal trade adjustment assistance under the federal trade adjustment assistance reform act of 2002, public law 107-210.
Documentation required for federally defined eligibility.
Applicants seeking coverage based on federally defined eligibility for FTAA must provide the following documents to prove eligibility.
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