Maryland Health Insurance Plan for the Uninsurable

The state of Maryland sponsors and manages a health insurance program for residents who are unable to obtain health insurance on the private market. The program is called the Maryland Health Insurance Plan (MHIP). The plan creates a high-risk pool and permits insurance providers to sell insurance plans to this group at a cost less than what the individual can expect to pay in the individual or group market. Residents with a chronic or preexisting condition that prevents them from obtaining access to affordable health coverage can enroll in MHIP. The state has made access available through CareFirst BlueChoice HMO and CareFirst BlueChoice PPO insurance providers.

Eligibility Requirements

• You can qualify to enroll in MHIP if you're a Maryland resident and meet one of the following eligibility requirements: you or your child has a qualifying medical condition; you were denied medical insurance for medical reasons in the past 6 months; your existing insurance plan doesn't cover your medical condition; or you're transferring from another state's insurance program for high-risk residents.

Coverage

• There are four different plans enrollees can choose from within the MHIP program. There are two PPO options, one HMO and one HDP. Each plan provides comprehensive medical services, such as routine doctor's visits, hospitalization and prescription drugs. You can request a booklet that explains what each of the four plan options' benefits includes. You can also find a detailed explanation of coverage in the Certificate of Coverage booklet. Both booklets can be accessed on the MHIP website.

Premiums

• Plan enrollees must pay a monthly premium for coverage just as they would if they were to purchase a plan privately. Plan premiums vary based on three things: the plan option you choose, coverage level and your age. Rates are set by insurance providers on an annual basis. All plan options except the HMO require a deductible for some medical services and prescription drugs. The HMO may require you to pay copayments at the time services are delivered. Low- and moderate-income individuals also may qualify for discounted premiums and lower out-of-pocket costs through the MHIP+ program. You'll need to complete an application to determine whether you qualify. The application is in addition to the MHIP program enrollment application.

Enrollment

• You can enroll in MHIP by downloading and completing an application on the program's website. As part of the application process, you'll need to confirm Maryland residency as well as providing other documentation. Mail the completed application form and accompanying documentation to the MHIP program Enrollment and Billing Department. The address is available on the program's website. Faxed applications aren't accepted. If your application is received and approved before the 15th of the month, coverage begins the first day of the next month. Coverage begins the first day of the second month following receipt and approval of applications after the 16th of the month.

Provider Selection

• Once you're enrolled, you can select from a list of approved providers available under the plan you select. The MHIP provides an online directory that makes searching easy.