Reciprocal Agreement

Not all, but number of states in U.S. have set condition of reciprocity agreement for accepting an applicant into the risk pool plan. In simple words reciprocity means that the individual is a participant of a state-sponsored health care plan but he has not used the lifetime maximum benefits admissible to him through that plan; and that he meets the pre-existing waiting period criterion. If an individual fulfills the above conditions he is eligible to apply for another state if he meets the residency requirements.

Most of the states do not allow an individual to participate in risk pool plan if he is:

• Eligible for Medicaid or Medicare Plan
• If he is already participant of Medicaid or Medicare plan

However, many states have introduced a high risk plan for individuals of above categories.

• An individual becomes ineligible for plan (termination of coverage) coverage when he terminates the plan coverage unless there is a period of 132 months gap between such coverage.
• If an individual has reached the authorized maximum benefit limit of the plan it renders that individual ineligible for the plan coverage.
• Inmates of public institutions are also not eligible for risk pool plan coverage.
• Some states have excluded certain medical conditions and diseases from the risk pool plan.
• Many states have put an ‘enrollment cap’ for their risk pool plans. According to this cap only decided number of individuals can be enrolled in a risk pool plan at a time. Remaining individuals are wait-listed for enrollment into plan.

Many states in the U.S. have introduced their risk pool plans. To provide information of these plans these states have made this information available on internet.