Utah Risk Pool

Risk Pool Name / Acronym
Utah Comprehensive Health Insurance Pool / HIPUTAH

Insurance Regulation Establishing Risk Pool
Utah State Legislature
1990

Utah Comprehensive Health Insurance Pool (HIPUTAH)

Utah Comprehensive Health Insurance Pool, established in 1991, provides health insurance coverage to Utah residents who cannot obtain private health insurance due to pre-existing health conditions.

Funding

HIPUtah is funded through premiums collected from persons enrolled in a health plan under the risk pool program. Additional funds to offset deficits come from especially dedicated state funds called the Utah Comprehensive Health Insurance Pool Enterprise Fund.

Plans Offered

HIPUtah offers three HMO plans and a High Deductible Health Plan (HDHP), which is designed to be used with a Health Savings Account (HSA).

Plan Benefits

The HIPUtah HMO plan offers one plan with deductibles of either $500, $1,000 and 2,500. For most in-patient covered medical expenses, the HIP Utah member is required to pay a 20% coinsurance. The maximum out-of-pocket limit is $2,000 including deductible, on the $500 deductible plan, $1,000 including deductible, on the $1,000 deductible plan and $6,000 including deductible, on the $2,500 deductible plan.

For the HDHP plan, the deductible and out of pocket maximum is $5,000. Once the deductible is met, 100% coinsurance for the covered services is paid.

HIPUtah Plan Brochure

Maximum Benefit Limits

The maximum benefits provided by HIPUtah are $300,000 each calendar year with a maximum lifetime benefit of $1,500,000.

Eligibility

  • Your must be a resident of Utah for the 12 months preceding your HIPUtah application submittal date

  • You must meet the underwriting criteria established by the State of Utah

  • You are HIPAA eligible and has at least 18 months of prior coverage, the most recent prior coverage being under a group health plan, government plan, or church plan, and has elected and exhausted COBRA or a state continuation plan where available

  • You apply for HIPUtah coverage within 63 days of termination from prior coverage

  • You are not eligible for Medicaid or Medicare unless you have a spend-down that exceeds the premium for a Hip Policy

  • Your previous health insurance coverage must have been involuntarily terminated and was not cancelled for non-payment of premium

  • You have not exhausted the maximum lifetime benefits under the risk pool

  • You must not be an inmate of a public institution

  • You must not be eligible for other public health insurance programs

  • You must not be eligible for group health insurance

  • You must not have over coverage that is substantially equivalent to HIPUtah coverage

  • You do not need to be a 12 month resident of Utah if you had coverage under another state risk pool plan and recently moved to Utah and apply for coverage within 63 days

  • You do not need to be a 12 month resident of Utah if you are a recent resident of Utah and are HIPAA eligible

Enrollment Periods

Once you have applied and been accepted for coverage under HIPUtah, you must meet with a HIPUtah representative within 90 days to complete the final interview before your coverage becomes effective. This final approval step is not required if you are HIPAA eligible.

Premium Payments

Premiums for the HIPUtah plan are based on your plan selection and age.

Premium Calculations

The current premium calculations are set at 200% of the standard risk rate provided by individual health insurance companies offering similar type coverage to eligible individuals in the state of Utah.

Pre-Existing Condition Waiting Periods

There may be a 6-month pre-existing medical condition waiting period following the effective date if in some cases. The waiting period of a person with a pre-existing condition is waived if the applicant is eligible for coverage under federal HIPAA regulations or the waiting period was satisfied under a similar plan from another state and the other state's benefit limitation was not reached.

Utah Comprehensive Health Insurance Pool Contact Information

HIP Utah
C/O SelectHealth
P.O. Box 30192
Salt Lake City, UT 84120-0192
Phone: 800-705-9173

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