Individual Market Guaranteed Issue - Kaiser State Health Facts

Individual Market Guaranteed Issue (Not Applicable to HIPAA Eligible Individuals), 2008

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	All Insurers Must Guaranteed Issue All Products?	All Insurers Must Guaranteed Issue Some Products?	Insurers of Last Resort?	High Risk Pool for Medically Eligible?	Guaranteed Issue Comments

United States	NA	NA	NA	NA	NA

Alabama	No	No	No	No
Alaska	No	No	No	Yes
Arizona	No	No	No	No
Arkansas	No	No	No	Yes
California	No	Yes, continuously for some individuals	No	Yes	Individual market insurers and HMOs must guarantee issue a standardized policy to those exhausting High Risk Pool coverage (36 months).
Colorado	No	No	No	Yes
Connecticut	No	No	No	Yes	The high risk pool is available for all qualified applicants, not just those that are medically eligible.
Delaware	No	No	No	No
District of Columbia	No	No	Blue Cross Blue Shield	No
Florida	No	Yes	No	No	Eligible individuals, who are uninsured for 6 months or have lost ESI, can buy a guaranteed issue limited benefit policy through the Cover Florida Health Care Program.
Georgia	No	No	No	No
Hawaii	No	No	No	No
Idaho	No	Yes, continuously for some individuals	No	No	Individual market insurers must guarantee issue standardized policies to the medically uninsurable. Insurers must offer basic, standard and catastrophic policies. These policies are called High Risk Pool Policies.
Illinois	No	No	No	Yes
Indiana	No	No	No	Yes
Iowa	No	No	No	Yes
Kansas	No	No	No	Yes
Kentucky	No	No	No	Yes
Louisiana	No	No	No	Yes
Maine	Continuous for all individuals	No	No	No
Maryland	No	No	No	Yes
Massachusetts	Continuous for all individuals	No	No	No
Michigan	No	Yes, periodically for some plans and for all individuals	Blue Cross Blue Shield	No	HMOs, after 24 months in existence, are required to guarantee issue to a limited number of applicants during one, 30 day open enrollment per year.
Minnesota	No	No	No	Yes
Mississippi	No	No	No	Yes
Missouri	No	No	No	Yes
Montana	No	No	No	Yes
Nebraska	No	No	No	Yes
Nevada	No	No	No	No
New Hampshire	No	No	No	Yes
New Jersey	Continuous for all individuals	No	No	No
New Mexico	No	No	No	Yes
New York	Continuous for all individuals	No	No	No
North Carolina	No	No	No	Yes
North Dakota	No	No	No	Yes
Ohio	No	Yes, periodically for all individuals	No	No	Individual market insurers must guarantee issue standardized policies on a periodic basis. Non-HMOs are required to guarantee issue standardized policies (up to a limited number determined of enrollees as determined by the state) for one 30 day period, annually. HMOs are required to guarantee issue standardized policies annually until reaching a state determined limited number. For HMOs, this period could extend beyond 30 days.
Oklahoma	No	No	No	Yes
Oregon	No	Yes, continuously for some individuals	No	Yes	Individual market insurers must guaranteed issue portability policies to individuals with 6 months of prior coverage.
Pennsylvania	No	No	Blue Cross Blue Shield	No
Rhode Island	No	Yes, continuously for some individuals	Blue Cross Blue Shield	No	Individual market insurers must guarantee issue all products to those with 12 months of continuous creditable coverage, provided the applicant is not eligible for alternative group coverage, Medicare or any other state health insurance plan.
South Carolina	No	No	No	Yes
South Dakota	No	No	No	Yes
Tennessee	No	No	No	Yes
Texas	No	No	No	Yes
Utah	No	Yes, continuously for some individuals	No	Yes	Individual market insurers that have not met enrollment cap must guarantee issue at least one individual market policy to those that are otherwise not eligible for any other type of health insurance coverage (i.e. group, HRP, etc.)
Vermont	Continuous for all individuals	No	No	No
Virginia	No	No	Blue Cross Blue Shield	No
Washington	Continuous for some individuals	No	No	Yes	Insurers in the individual market must guarantee issue all products to applicants achieving a minimum score on a state mandated health status questionnaire (or health screen). Those applicants, not eligible for guaranteed issue plans, are referred to the high risk pool.
West Virginia	No	Yes, periodically for some plans for all individuals	No	Yes	HMOs with greater than 5 years in the market or with enrollment not less than 50,000, must guarantee issue during annual 30 day open enrollment period.
Wisconsin	No	No	No	Yes
Wyoming	No	No	No	Yes

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Notes:	This chart is not applicable to HIPAA eligible individuals. For rules that apply to HIPAA eligible individuals refer to HIPAA Rules.
Sources:	Data as of December 2008. Data compiled through review of state laws and regulations and interviews with state health insurance regulatory staff. Data collection and analysis by researchers at the Health Policy Institute, Georgetown University. Special Data Request, February 2009.
Definitions:	Health insurance sold on a guaranteed issue basis cannot turn applicants down based on health or risk status. In a few states, such as New York, all individual market insurers must guarantee issue all individual market plans that the insurer sells to all applicants. In others states guaranteed issue requirements are much less restrictive. For example, in Calfornia, individual market insurers are only required to guarantee issue one plan and only to individuals exhausting HRP coverage.

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