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Who is eligible to participate in the temporary high-risk pool? <br />Individuals with pre-existing medical conditions are eligible to receive benefits through the temporary high-risk pool if <br />they have not had health insurance coverage for the past six months. <br />When will the temporary high-risk pool be created? <br />The temporary high-risk pool will be effective July 1, 2010. <br />How will the temporary high-risk pool operate? <br />States have the option to run the high-risk pool program themselves, but if states choose not to run the high-risk pool <br />program, eligible individuals can apply for coverage through a federal fallback high-risk pool. The Department of Health <br />and Human Services gave states notification on April 2, 2010 about the different options available for operating the <br />temporary high-risk pool, as follows: 1) Create a new high-risk pool if the state currently lacks one; 2) If the state already <br />has ahigh-risk pool, operate a new high-risk pool alongside the existing state high-risk pool; 3) Build upon other <br />established coverage programs for high-risk individuals; 4) Provide subsidized coverage by contracting with current <br />HIPAA insurance carriers or carriers of last resort. States were required on April 30, 2010 to indicate which option they <br />would pursue. <br />For states that did not select one of the options outlined by the HHS Secretary, how will the temporary high-risk pool <br />operate in their state? <br />In states that elected not to choose one of the options for operating the temporary high-risk pool, the Department of Health <br />and Human Services will operate the temporary high-risk pool in the state. <br />What type of health care coverage will be available through the temporary high-risk pool? <br />The Secretary of the Department of Health and Human Services will establish a minimum set of benefits to be included in <br />the health plans. Pre-existing medical conditions will be required to be covered, and the plans must cover at least 65 <br />percent of health caze costs. <br />How will premium rates for the temporary high-risk pool be set? <br />Although the population participating in the temporary high-risk pool will have higher health risks due to their pre- <br />existing health conditions, premiums will be set according to standard population rates. Premiums will be based on age, <br />geographic area, family composition and tobacco use. <br />Will there be limits on out-of-pocket medical spending for individuals participating in the temporary high-risk pool? <br />Yes-excluding premiums, annual out-of-pocket spending will be limited to $5,950 for individuals and $11,900 for <br />families participating in the temporary high-risk pool. <br />How much federal funding is available for the temporary high-risk pool? <br />The health reform law contains $5 billion for the administration of the temporary high-risk pool. <br />Will individuals who currently receive coverage through a state high-risk pool be transferred to the temporary high- <br />riskpool? <br />No-individuals receiving coverage through an existing state high-risk pool (currently 34 states operate these types of <br />high-risk pools) will keep their current coverage through those high-risk pools. <br />9 <br />