Eligibility Requirements for MHIP Plans
MHIP Standard
An applicant is eligible to enroll in MHIP Standard if the individual is a resident of Maryland and meets one of the following requirements:
- has a qualifying medical or health condition that is included on the list of conditions adopted by the MHIP Board of Directors;
- has been denied health insurance coverage for medical reasons within the last six months;
- is enrolled in, or has been offered, individual health insurance that:
- limits, restricts or blocks coverage for a specific medical condition; or
- has benefits similar to MHIP's benefits but costs more due to a health condition;
- has federal guaranteed-issue rights under the Health Insurance Portability and Accountability Act (HIPAA) due to loss of group coverage; and have exhausted any right to continuation of that coverage
- is eligible for the Health Care Tax Credit under §35 of the Internal Revenue Code;
- is transferring from a high-risk pool in another state; or
- is a dependent of an individual who is eligible for coverage.
Note: Individuals who are eligible for Medicaid, Medicare, employer-sponsored coverage or any other comparable insurance plan are not eligible for MHIP Standard.
MHIP Federal
An individual is eligible to enroll in MHIP Federal if he or she is a resident of Maryland and meets the following requirements:
- is a citizen or national of the United States, or lawfully present in the United States;
- has not had health insurance for a continuous six-month period of time immediately prior to the date of application to the federal high risk pool program; and
- meets one of the following criteria:
- has a qualifying medical or health condition that is included on the list of conditions adopted by the Board of Directors for MHIP by regulation;
- has been denied health insurance coverage for medical reasons within the last six months; or
- is enrolled in, or has been offered, individual health insurance that:
- limits, restricts or blocks coverage for a specific medical condition;
- has benefits similar to MHIP's benefits but costs more due to a health condition; or
- is a child who qualifies for medical reasons and submits an application through a parent or guardian.
MHIP+ / MHIP Federal +
MHIP+ or MHIP Federal + provides discounted premiums and, in some cases, cost sharing to individuals with limited income. An individual is eligible for MHIP+ or MHIP Federal+ if the individual meets both of the following requirements:
- is eligible for MHIP Standard or MHIP Federal; and
- has annual household income that meets the guidelines shown on the MHIP enrollment application form.
Resources
For more information on all of the plan benefits, including copays, deductibles and covered services, as well as premiums, please refer to the Application Booklet. A detailed explanation of MHIP's coverage is contained in the Certificates of Coverage found on the Forms & Documents page.
To apply for any of our plans, you must complete the MHIP Enrollment Application(s). Call us if you need help at 1-888-444-9016, Monday through Friday, 8 a.m. – 5 p.m.
