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Indiana State Department of Health

HIV/AIDS in Indiana > Hemophilia > Eligibility for Participation Eligibility for Participation

Indiana State Hemophilia Insurance Program

FACT SHEET

The Indiana State Hemophilia Insurance Program (ISHIP) is operated by the Indiana State Department of Health through its Division of HIV/STD. It provides insurance premium assistance through the Indiana Comprehensive Health Insurance Association (ICHIA) for eligible individuals with hemophilia and other related conditions.

In order to qualify for ISHIP, a person must meet the following criteria:

1. Residency. The applicant must reside in Indiana (currently and for the past twelve months).
2. Age. The applicant must be 64 years of age or younger.
3. Diagnosis. The applicant must be diagnosed with either hemophilia or von Willebrand disease.
4. Income. The applicant must document income that is equal to or less than total liabilities, including the cost of factor. Total liquid assets cannot exceed $10,000 (excluding retirement fund, 401K, deferred compensation, federal thrift savings program, and Ricky Ray settlement).
5. Health Care Coverage. The applicant must not be eligible for Medicare, Medicaid, or private insurance. If the applicant has, or has access to, any health insurance coverage (e.g., insurance coverage offered by an employer) but has chosen to decline the coverage, that applicant is not eligible for ISHIP unless one of the following conditions applies:

a. The premium cost exceeds the cost of an ICHIA premium for similar coverage; or
b. The coverage contains material underwriting restrictions on either hemophilia or von Willebrand disease.

Below are answers to a series of commonly asked questions about the program, its benefits, and its limitations.

Q: Why should I apply for this insurance program?
A: ISHIP can help eligible individuals afford quality medical care. The average cost to the consumer on ISHIP is only a fraction of the potential out-of-pocket cost for treating hemophilia and related conditions without insurance coverage.

Q: What is the Indiana Comprehensive Health Insurance Association Program?
A: ICHIA is the state’s high-risk insurance pool. It was created by State law and became effective on July 1, 1982. It exists to provide comprehensive insurance coverage to those who are otherwise ineligible for traditional insurance.

Q: If I have insurance now, should I drop it?
A: No, unless your premium cost exceeds that of an ICHIA policy for similar coverage or your policy contains a material underwriting restriction on your hemophilia or von Willebrand disease, you should not cancel your existing coverage.

Q: Will I have to pay for anything?
A: Yes, enrollees are responsible for the cost of all co-payments, deductibles, out-of-network charges, and the cost of non-covered services.

Q: What benefits are included in and excluded from ICHIA’s coverage?

Q: When would my insurance coverage begin?
A: Once the applicant is determined to be eligible, the coverage generally becomes effective on the first day of the month following the date that ICHIA received the completed application packet from ISHIP.

Q: Is my disease considered a pre-existing condition?
A: Yes, and unless the applicant meets ICHIA’s requirements for a “Waiver of Pre-Existing Conditions,” there is a three-month waiting period for coverage of any previous or existing injury or illness. This means that medical care for hemophilia and von Willebrand disease is generally not covered for the first three months. More information about the waiver can be found in the ICHIA packet.

Q: How often is my eligibility reviewed?
A: Eligibility is reviewed annually. Each year, the applicant, or person(s) responsible for the applicant, will receive a letter requesting the submission of the previous year’s signed income tax return and relevant W-2 forms, written verification of any IRS extension(s), or proof of lack of income. Other documentation may also be requested to verify current residency, age, health care coverage, living expenses, and current cost of factor.

Q: Why is the Department of Health helping to pay for insurance?
A: The Indiana State Department of Health is committed to assisting all persons diagnosed with hemophilia and related conditions and strives to help provide the most comprehensive health care services available. The Indiana State Hemophilia Insurance Program is an important and cost- effective component in this effort.

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This fact sheet contains information regarding the Indiana State Hemophilia Insurance Program only. The ICHIA packet referred to above explains the actual terms of the insurance policy, your rights, obligations, and benefits. For more information regarding ISHIP, you may contact the Enrollment Specialist at 866-588-4948.