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Most Kentucky residents are covered by an employer-sponsored group health plan. If you are not covered by such a plan, you can buy health insurance from a private health insurance company. In this case, your health status could determine your ability to purchase individual health insurance Kentucky. In other words, private companies selling health plans could turn you down because of your existing and past health status. However, there are certain exceptions to this rule. When You Cannot Be Refused KY Individual Health Insurance • You cannot be refused coverage because of genetic conditions or because of the results of a genetic test and your family’s health history. • If you are HIPAA eligible, you are guaranteed the right to buy individual health insurance Kentucky coverage of some kind only from Kentucky Access with no pre-existing condition exclusion periods. Under Kentucky Access you have three plan options – one fee-for-service (FFS) plan and two preferred provider organization (PPO) plans, all with varying deductible choices. Coverage includes hospitalization, surgical expenses, doctor visits, preventive care, maternity services, and home health care. You can add on enhanced coverage for prescription drugs and mental health/substance abuse for an additional premium. • In KY, a newborn baby is automatically covered under the parents’ individual health insurance Kentucky plan for the first 31 days. To extend this coverage, the parents may have to enroll the newborn in the plan and pay the premium within the 31 day period. • Kentucky health insurance law allows mentally retarded and physically disabled dependents to stay on their parents’ health plan after they reach the age at which dependent coverage is usually terminated, if certain conditions are met. Kentucky Health Care Coverage through the PCIP Program Kentucky residents with pre-existing conditions are eligible to apply for coverage through the Pre-Existing Condition Insurance Plan (PCIP) program run by the U.S. Department of Health and Human Services. Conditions to qualify for coverage: • You are a citizen or national of the United States or lawfully present in the United States. • You must have been uninsured for at least the last six months before you submit your application. • You must have a pre-existing condition or have been denied coverage because of your health condition. Under the PCIP program, you are eligible for several health benefits such as primary and specialty care, hospital care, and prescription drugs, which are available to treat even preexisting conditions. Monthly premiums vary according to age and options which come under three heads - ‘Standard’, ‘Extended’, and HSA. Individual Health Insurance Kentucky – Other Costs for Individuals with Pre-existing Conditions: During the year 2011, you have to pay other costs too, such as a $1,000 to $3,000 deductible, which varies by plan. The deductible pays for your covered health benefits (excluding preventive care) before you plan begins to pay. Your plan could have a separate drug deductible option. After your deductible, other payments would include: a $25 copayment for doctor visits, $4 to $40 for most prescription drugs, and 20 percent of the costs of any the benefits your plan covers. The maximum amount of your out-of-pocket costs is $5,950 per year. If you opt for out-of-network care, you could end up paying more for all these services.
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