Health Insurance in Alabama

Health Insurance in Alabama

Health insurance has always been an essential element of a personal finance plan of any family. Buying appropriate health insurance coverage for your family is expensive as well as requires a comprehensive appraisal of all potential risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are the working families. The unaffordable health insurance costs expose these families, especially the children, to financially crippling hazards. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs.

According to the America’s Health Rankings 2008 list, Alabama climbed to the 40th position from its 45th position in the year 2007, showing a reasonable amount of improvement on its overall health score.. The state of Alabama, having the population of more than four million people, boasts of both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Alabama who meet specific eligibility requirements such as age, income and military service.

The Alabama Department of Insurance closely regulates all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, approximately 14% of the population remains uninsured, even as the debate continues to provide affordable health insurance in the state. Nearly 29.2% uninsured citizens come under the 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

When considering purchasing health coverage, it is important to consult with a licensed health insurance agent/broker to avail the suitable health insurance alternatives.

INDIVIDUAL/FAMILY HEALTH INSURANCE

Below is the guidelines for applying for and obtaining individual health insurance in the state of Alabama. These regulations apply to all insurance companies offering individual or family health insurance in Alabama:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
6 months
Look Back Standard
Objective
Mandatory Benefits
Cancer screening for women, breast cancer screening, direct access to OB/GYNs, OB/GYN as primary care physician,
Market Rate Restrictions
None
Guaranteed Issue Options
None

STATE COBRA VARIATIONS FOR SMALL GROUPS

Below are the COBRA guidelines for small groups in the state of Alabama. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
No
Eligible Group Sizes
NA
Extension of Benefits Period – Standard
NA
Extension of Benefits Period – Disabled
NA
Maximum Premium Increase
NA
State Legislation Reference
NA
Additional Notes
NA

SMALL GROUP HEALTH INSURANCE

Below is the guidelines for small group health insurance in the state of Alabama. These regulations apply to all insurance companies offering small group health insurance in Alabama:

Small Group Size

2-50
Employee Qualifications
Must work for at least 6 months out of the
year, and 20 hours per week.
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands with Limits
Rate Adjustment Factors
20%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as Individual

STATE SPONSORED HEALTH INSURANCE PROGRAMS

There are several state sponsored health insurance programs in the State of Alabama to assist those without insurance in obtaining adequate coverage.
High-Risk Pools

Some states offer specialized state-sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Alabama is summarized in the chart below:

Plan Name
Alabama Health Insurance Plan (5AHIP)
Website
https://www.alseib.org/Default.aspx
Phone Number
866-833-3375, 334-263-8311
HIPPA Eligibility Required?
Yes
Available Carriers
Blue Cross and Blue Shield of Alabama, United HealthCare
Pre-Existing Condition Waiting Period
None
Enrollment Periods
Within 63 days of expiration of prior coverage
Premium Limits
No more than 125% of standard rates
Lifetime Maximum Benefit
$1 Million
Special Notes
Exclusively available for people who have lost their group health insurance and have exhausted or have no COBRA option available

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Alabama provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
All Kids
Website
https://www.alabamapublichealth.gov/allkids/
Phone Number
877-774-9521, 334-206-5568
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Blue Cross Blue Shield of Alabama
Length of Coverage
12 months continuous coverage
Residency Requirements
Alabama resident, U.S. Citizen or eligible immigrant
Other Eligibility Requirements
Not covered under any health insurance
Not covered by or eligible for Medicaid
If previous coverage was voluntary dropped, 3-month waiting period is applied.
Pre-Existing Condition Exclusions
No
Cost
$50 to $100 per child, per year for the first 3 children per family (5no cost for additional children)

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Alabama.

Governing Agency
Alabama Medicaid Agency
Website
https://www.medicaid.alabama.gov/
Phone Number
334-242-5000
Residency Requirements
Alabama residents, U.S. Citizen or legal immigrant
Federal Poverty Line Income Limits
Working Parents – 19% of FPL
Non-Working Parents – 13% of FPL
Pregnant Women – 133% of FPL
Children – 100-133% of FPL

Additional Resources

Alabama Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Alabama’s public and private health care choices for individuals and groups with various demographic profiles. It also provides a reference list of phone numbers and Web sites.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage including individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Alabama: At-A-Glance
Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.

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