The Kentucky Major Medical Insurance Plan (MRMIP) provides access to health insurance for Kentucky Residents who are not able to be underwritten by traditional individual insurance plans. The legislation passed in 1989 and became operational March, 1991.

ELIGIBILITY

Who is eligible to participate?

The participant must be:

  • a permanent resident of Kentucky
  • not eligible for Parts A and B of Medicare except for end-stage renal disease;
  • not eligible for COBRA or COBRA benefits;
  • able to demonstrate inability to secure adequate coverage, within the previous 12 months due to being:
  1. denied individual coverage,
  2. involuntarily terminated for reasons other than non-payment of premium or fraud
  3. requested to pay premium in excess of program subscriber rate

Premium costs

Generally, you will pay from 25 percent to 37.5 percent more for the MRMIP than you would for a private plan, were you eligible to enroll in one. Keep in mind however, that you must be turned down for an individual plan in the private market in order to qualify. *see above

Maximum benefit
$75,000 annually, $750,000 lifetime.

Deductibles
None, all plans offer first dollar coverage with co-pays.

Maximum annual out-of-pocket
$2,500/Individual
$4,000/Family

Waiting Period and Pre-existing Conditions
For PPO plans, any condition for which you've sought medical advice, care or treatment within the preceding six months has a 90-day exclusion period. You must still pay your premiums to the MRMIP during this period.

For HMO plans, there is a 90-day post-enrollment waiting period for which NO services are provided. However, you also do not pay premiums during this period.

Waiver of waiting period
In some cases, the waiting period can be waived: (This can be very good news for you if you've had preexisting coverage)

  • if your waiting period has already satisfied under prior coverage and you apply for the MRMIP within 63 days following termination of that prior coverage;
  • or if you were covered under a similar program in another state within the last 12 months;
  • or if a you had employer-sponsored coverage that ended because you lost that job, or because the employer stopped offering or providing health coverage, or because the employer stopped making contributions towards your health coverage and you apply for the MRMIP within 180 days following the termination of that coverage.

Sometimes, the plan may be closed to new enrollees

You may be put on a waiting list if enrollment in the MRMIP is full. If you are on the waiting list for 180 or more days, the time you spend on it is Time you spend on it is credited toward the waiting period for pre-existing conditions.

Medicare Supplement Plan
MRMIP does not offer a Medicare Supplement Plan.

HIPAA
This plan is NOT the individual market portability alternative for Kentucky?

Federal Health care Tax Credit payments

MRMIP plans are not currently eligible for these payments.

Health Savings Accounts (HSA)