The following eligibility requirements are meant to serve as general information only.  Please contact your health insurance agent or MCHA Customer Service (1-866-894-8053) for additional information.  You may also refer to the “MCHA Instructions & Application for Individual Coverage” for more detailed information.

There are five (5) different eligibility categories by which you can apply for MCHA coverage. 

1. Loss of Group Coverage:

You are a Minnesota resident on the date of application for MCHA coverage, and have lost group coverage.  You must be an “eligible individual” under the Health Insurance Portability and Accountability Act (HIPAA).  An “eligible individual” is a person who:  

• Elected and exhausted health benefits through COBRA or a similar State of Federal continuation plan;
• Had 18 months of continuous coverage (uninterrupted qualifying coverage) under a health plan with the most recent coverage being an employer sponsored, church or government plan (state risk pool plans must be 501c(26) or the state’s HIPAA alterative mechanism);
• Have had no more than a 63 day break in coverage;
• Your prior coverage must not have been subject to termination of COBRA coverage because you failed to pay the premium or because you committed acts of fraud; and
• You cannot be eligible for Medicare or Medicaid, and must not have other health insurance coverage (as a dependent or otherwise).

Required documentation:  Documentation supporting eligibility under this category includes a copy of the Certificate of Creditable Coverage, a HIPAA document, or documents that collaborate creditable coverage   (including explanations of benefits (EOBs) or other correspondence from a plan or issuer indicating coverage, pay stubs showing a payroll deduction for health coverage, a health insurance identification card, records from medical care providers indicating health coverage, third party statements verifying periods of coverage, and any other relevant documents that evidence periods of health coverage).

(If you are eligible under this category, the effective date of coverage will be the date the application, all required documentation and premium is received by MCHA.  A pre-existing limitation condition period does not apply.)

2. Health Coverage Tax Credit (HCTC) Program:

You are a Minnesota resident on the date of application for MCHA coverage, and are also eligible for the Health Coverage Tax Credit (HCTC) program.  You must be Department of Labor certified to receive partial coverage of your health insurance premiums under the IRS Health Coverage Tax Credit (HCTC).  You may receive benefits through Trade-Adjustment Assistance (TAA), Alternative Trade Adjustment Assistance (ATAA) the Pension Benefit Guaranty Corporation (PBGC). 

Required documentation:  You must have registered for and received notice from the HCTC program that you are eligible for the assistance.  You must submit a copy of the HCTC candidate letter.

(If you are eligible under this category, the effective date of coverage will be the date the application, all required documentation and premium is received by MCHA.  A pre-existing limitation condition period does not apply.)

3. Ineligible for the Federal Medicare Program:

You have been a Minnesota resident for the six months immediately prior to the date of application for MCHA coverage, and have reached age 65 or over and are not eligible for the health insurance benefits of the Federal Medicare Program. 

Required documentation:  You must submit a letter from Social Security stating you are ineligible for Medicare.   

(If you are eligible under this category, the effective date of coverage will be the date the application and all required documentation and premium is received by MCHA or a future date as identified by you.  A pre-existing limitation condition period does not apply.)

4. Health Related Rejection: 

You have been a Minnesota resident for the six months immediately prior to the date of application for MCHA coverage, and within the past six months, have been rejected for individual health coverage from a Minnesota based health insurance carrier or have received a rejection of coverage from a health insurance agent, due to health related reason(s). 

Required documentation:  You must submit a notice of rejection (with the companies name and dated within the past 6 months), or your insurance agent must complete the “Agent Certification of Health Related Rejection” section on the MCHA application. 

(If you are eligible under this category, the effective date of coverage is the date the application and all required documentation and premium is received by MCHA, or if a pre-existing condition limitation waiver is requested and approved, the effective date will be backdated to the day following termination of prior coverage.  If you choose a date other than the day after termination of prior coverage, the waiver is relinquished and a six-month pre-existing condition limitation will apply to your policy. MCHA will notify you by mail if your request for a waiver of the pre-existing condition limitation has been denied.)

5. Presumptive Condition(s): 

You have been a Minnesota resident for the six months immediately prior to the date of application for MCHA coverage, and have been treated within the last three (3) years for one of the special medical “presumptive conditions” listed below. 

Required documentation:  Your physician must complete the “Physician’s Statement” on the MCHA application, certifying eligibility, and identifying you have one of the following conditions or diagnoses:  

• AIDS/HIV
• Alzheimer’s Disease
• Amyotrophic Lateral Sclerosis (ALS)
• Angina Pectoris
• Anorexia Nervosa or Bulimia
• Aortic Aneurysm
• Ascites
• Chemical Dependency
• Chronic Pancreatitis
• Chronic Renal Failure
• Cirrhosis of Liver
• Coronary Insufficiency
• Coronary Occlusion
• Crohn’s Disease (Regional Eneritis)
• Cyctic Fibrosis
• Dermatomyositis
• Friedreich’s Ataxia
• Hemophilia
• Hepatitis C
• History of Major Organ Transplant
• Huntington Chorea
• Hydrocephalus
• Insulin Dependent Diabetes
• Leukemia
• Malignant Lymphoma
• Malignant Tumors
• Metastatic Cancer
• Motor/Sensory Aphasia
• Multiple Sclerosis
• Muscular Dystrophy
• Myasthenia Gravis
• Myocardial Infarction
• Myotonia
• Open Heart Surgery
• Paraplegia
• Parkinson’s Disease
• Polyarteritis Nodosa
• Polycystic Kidney
• Primary Cardiomyopathy
• Progressive Systemic Sclerosis (Scleroderma)
• Quadriplegia
• Stroke
• Syringomylia
• Systemic Lupus Erythematosis (SLE)
• Wilson’s Disease

(If you are eligible under this category, the effective date of coverage is the date the application and all required documentation and premium is received by MCHA, or if a pre-existing condition limitation waiver is requested and approved, the effective date will be backdated to the day following termination of prior coverage.  If you choose a date other than the day after termination of prior coverage, the waiver is relinquished and a six-month pre-existing condition limitation will apply to your policy. MCHA will notify you by mail if your request for a waiver of the pre-existing condition limitation has been denied.)