About Take Care Arkansas

About

If you’ve had a problem getting health insurance due to a pre-existing condition and have been uninsured for at least the past six months, you need to know about Take Care Arkansas – the federally supported pre-existing condition insurance plan administered in Arkansas by the Arkansas Comprehensive Health Insurance Pool. The plan is offered through the temporary federal risk pool created by the Patient Protection and Affordable Care Act. Premium payments for Take Care Arkansas enrollees will be about the same as what an average person pays in the individual health insurance market and will vary by age and whether or not you use tobacco products. The cost of the program is subsidized by federal funds. The new plan will provide health insurance coverage for a limited time, based on availability of federal funding. Enrollment is limited. The plan will not deny any applicant coverage or benefits simply because of health status. Coverage is expected to last until 2014, when similar coverage will be available through health insurance exchanges.

Who is eligible?

To qualify for Take Care Arkansas coverage you must:

• Be a resident of Arkansas and either a U.S. citizen or national or an alien lawfully present in the United States
• Within the past 6 months, have been denied coverage in Arkansas due to health conditions or have been offered coverage in Arkansas with a rider excluding certain health conditions
• Have been uninsured for 6 months prior to submitting your application

If you are enrolled in another state’s Pre-Existing Insurance Plan and move to Arkansas, you may enroll in Take Care Arkansas immediately.

What does Take Care Arkansas Cover?

The plan offers many if not all of the same benefits you’d get from a private health insurance plan. This includes:

• Prescription drug coverage
• Care in medical offices for illness or injury
• Emergency services
• Inpatient and outpatient hospital services
• Coverage for pregnancy*
• Certain transplants
• Diabetes treatment, equipment and supplies
• Home health care, skilled nursing and hospice care
• Outpatient rehabilitative services
• Wellness services and screening
• Behavioral health and substance abuse services
• And more

*A newborn is not covered under the mother’s policy.

What plan benefit options are available?

Take Care Arkansas is an individual, comprehensive major medical policy with an annual deductible of $1,000. Your annual out-of-pocket maximum for services performed by network providers is $2,000. Prescription drug coverage has $10, $30 and $70 copayments based on the medication drug list (formulary). Download Detailed Outline of Coverage and Rates (PDF)

How much are premium payments?

Premiums vary based on age and whether or not an Insured Person has used tobacco products within the last 12 months. An Insured Person may pay premiums on a monthly or quarterly basis. The first premium is due with the Application. The following chart reflects current monthly premium rates: $1,000 Deductible Plan Rates:

HOW DO I PROVE THAT I HAVE A PRE-EXISTING CONDITION?

1. Provide evidence that within the last six months, you have received: (a) a notice of rejection for individual health coverage; (b) an offer (which you did not accept) of individual health coverage with a rider excluding particular medical condition(s); or (c) an offer (which you did not accept) of individual health coverage that is twice as much as the PCIP premium applicable to you.
2. Provide a physician's statement reflecting that within the last five years before your application is submitted you either (a) received medical advice regarding any of the conditions listed below; or (b) had treatment recommended by a physician or received from a physician regarding any of the conditions listed below.