Eligibility - HIPIOWA

General Eligibility Requirements

Coverage is available to persons who meet the following general requirements:

You must meet one of the Eligibility Categories listed below.
If you are applying under Medical Eligibility, You must be a resident of the State of Iowa – “resident” means a person who has been legally domiciled in the State of Iowa for a period of of at least 60 days for purposes other than obtaining insurance. Domicile denotes a person’s permanent home and place of habitation. You must attach evidence of residency with this application.

If you are a HIPAA Eligible Individual, TAA Eligible Individual or you are coming from a Basic and Standard Plan, You must be a resident of the State of Iowa, although you are not required to satisfy the 60 day time frame nor are you required to attach evidence of residency with this application.
Iowa Code Section 514E.7.5 provides: “An individual is not eligible for coverage by the association if any of the following apply: . . . (d) The individual premiums are paid for or reimbursed under any government sponsored program or by any government agency or health care provider, except as an otherwise qualifying full-time employee, or dependent of the employee, of a government agency or health care provider.” Thus, HIPIOWA does not knowingly admit individuals into the program if the premiums are paid as proscribed in Section 514E.7.5.d.

Medical Eligibility

(At least one of the following must apply to be considered under the Medical Eligibility guidelines)

A notice of rejection of health insurance coverage within the last nine months.
A notice of health insurance benefit reduction of limitation which substantially reduces benefits compared to benefits available to others such as a rider which excludes or modifies benefits for a condition.
A notice of refusal to issue insurance except at a rate exceeding the plan rate of a comparable HIPIOWA plan.
Other involuntary termination (other than non-payment)

Medical Condition

If you have been a legal resident of the State of Iowa for the past 60 days and you suffer from one of the following, you are eligible under the Medical Condition.

Acquired Immune Deficiency Syndrome (AIDS)
Angina Pectoris
Arteriosclerosis Obliterans
Artificial Heart Valve
Ascites
Cardiomyopathy
Chemical Dependency
Cirrhosis of the Liver
Coronary Insufficiency
Coronary Occlusion
Cystic Fibrosis
Dermatomyositis
Friedreichs’s Disease
Huntington’s Disease
Hydrocephalus
Intermittent Claudication
Juvenile Diabetes
Kidney Failure requiring dialysis
Lead Poisoning with Cerebral Involvement
Leukemia
Lupus
Malignant Tumor ( treat within four years)

Metastatic Cancer
Motor or Sensory Aphasia
Multiple or Disseminated Sclerosis
Muscular Atrophy or Dystrophy
Myasthenia Gravis
Myotonia
Open Heart Surgery
Paraplegia or Quadriplegia
Parkinson’s Disease
Peripheral Arteriosclerosis (if treatment within last three years)
Polyarteritis (periarteritis nodosa)
Postero-lateral Sclerosis
Psychotic Disorders
Silicosis
Splenic Anemia (True Banti’s Syndrome)
Still’s Disease
Stroke (CVA)
Syringomyelia
Tabes Dorsalis (locomotor ataxia)
Topectomy and Lobotomy
Wilson’s Disease

Federal Eligibility

HIPAA Eligible Individual–You must be defined as an “Eligible Individual” according to the Health Insurance Portability and Accountability Act, meaning that you:
1. Must have had 18 months or more of creditable coverage without a break of 63 full days prior to applying for this plan;
2. Must have had the most recent prior creditable coverage under a group health plan, governmental plan or church plan (or under health insurance coverage offered in connection with such a plan);
3. May not be eligible for a group health plan;
4. May not be eligible for Medicare or Medicaid;
5. May not have lost the most recent coverage because of fraud or non-payment of premiums;
6. If offered COBRA or a similar state program, must elect and exhaust such coverage
Federal Trade Act Eligible Individual
1. Must be able to provide supporting documentation of eligibility.

Basic and Standard Eligibility

You are eligible if you are a current Basic and Standard Policy Holder.

Not Eligible for HIPIOWA Coverage

You are not eligible if you meet any of the criteria listed below:

You are not a resident of the State of Iowa.
You have terminated coverage in HIPIOWA within the last 12 months, unless you can show continuous other coverage which has been involuntarily terminated for any reason other than nonpayment of premiums; (This does not apply to HIPAA Eligible or TAA Eligible Individuals)
You are an inmate of a public institution; (This does not apply to HIPAA Eligible or TAA Eligible Individuals)
You have been paid the maximum allowable benefits payable under this program: or
You are eligible for a group plan through an employer;
You are eligible for public programs for which the individual premiums are paid for or reimbursed under any government sponsored program or by any government agency or health care provider.