FOR IMMEDIATE RELEASE
August 23, 2010
Contact: Jason Moon 517-335-1700
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LANSING- The Office of Financial and Insurance Regulation (OFIR) announced today that an agreement has been reached that will offer coverage to uninsured Michigan citizens who have been unable to obtain health coverage because of a pre-existing health condition . Coverage will be offered through Michigan-based HMO Physicians Health Plan of Mid-Michigan (PHP).PHP has contracted directly with the U.S. Department of Health and Human Services (HHS) to administer this program.

"Michigan residents who have been denied care because of a pre-existing condition will now have another chance for affordable coverage and the peace of mind that comes with it, " said Governor Jennifer M. Granholm. " This program will provide individuals with pre-existing conditions the help they need as the nation transitions to a more competitive and fair marketplace in 2014 ."

"This is great news for Michigan consumers who have been unable to obtain affordable health care because of a medical condition," said OFIR Commissioner Ken Ross. "This program will provide thousands of uninsured Michigan citizens with access to quality, affordable health insurance through a local job provider, PHP - a well-respected Michigan health plan."

Michigan's first approach to implement a high risk pool was through a Request for Proposal (RFP) process where both PHP and Priority Health, another Michigan-based health plan, were selected to partner with the state as the insurers in the pool. But when the Michigan Legislature failed to take action to allow the state to spend federal funds, OFIR worked with PHP to have HHS contract directly with the HMO, because HHS would only work with one vendor in each state.

"Priority Health, which was originally selected to provide coverage in a majority of the state's counties, understood the significance of having a Michigan job provider as the pool administrator. Priority Health graciously stepped back and allowed PHP to be the program administrator," added Ross. "Both companies should be commended for their hard work on this important issue."

OFIR will have regulatory oversight over the state-implemented pool, which will be funded entirely by subscriber premiums and an estimated $141 million in federal subsidies. The temporary pool will operate until January 1, 2014, when federal law requires all insurers to accept individuals regardless of pre-existing conditions.

Coverage provided by the pool will be more comprehensive and the offerings will be, in many cases, less expensive compared to products currently available in the individual market.

Enrollment is scheduled to begin August 31, 2010 and coverage is scheduledto start October 1, 2010.

Information for Consumers:

Michigan residents with pre-existing conditions who have been uninsured for the previous six months will be eligible to enroll. Consumers interested in this program should begin collecting the documents that will be required for enrollment, including:

• Poof of U.S. citizenship or legal residency (i.e. birth certificate) and Michigan residency (i.e. state driver's license).  
• Certification by a physician (i.e. doctor's letter), issued within the past six months, demonstrating that the individual suffers from a medical condition found in the pool's list of pre-existing conditions , OR
• Evidence that, for health reasons, a carrier has refused to issue coverage to the individual within the previous six months (i.e. health insurance company denial letter).
  

For a list of the pool's pre-existing conditions, visit: http://www.michigan.gov/documents/dleg/Pre-Ex_330602_7.pdf

Michigan consumers interested in detailed enrollment, benefit and eligibility information should contact PHP weekdays from 9:00 am - 5:00 pm EST at 877-459-3113 .

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Jason Moon
Public Information Officer
Office of Financial and Insurance Regulation
Phone: (517) 335-1700
moonj@michigan.gov
www.twitter.com/miofir
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