GENERAL ELIGIBILITY REQUIREMENTS

Coverage is available to persons who meet the following general requirements:

1. You must meet one of the Eligibility Categories listed below.
2. If you are applying under Medical Eligibility, You must be a resident of the State of Iowa - "resident" means a person who has been legally domiciled in the State of Iowa for a period of of at least 60 days for purposes other than obtaining insurance. Domicile denotes a person's permanent home and place of habitation. You must attach evidence of residency with this application.
3. If you are a HIPAA Eligible Individual, TAA Eligible Individual or you are coming from a Basic and Standard Plan, You must be a resident of the State of Iowa, although you are not required to satisfy the 60 day time frame nor are you required to attach evidence of residency with this application.

MEDICAL ELIGIBILITY

(At least one of the following must apply to be considered under the Medical Eligibility guidelines)

1. A notice of rejection of health insurance coverage within the last nine months.
2. A notice of health insurance benefit reduction of limitation which substantially reduces benefits compared to benefits available to others such as a rider which excludes or modifies benefits for a condition.
3. A notice of refusal to issue insurance except at a rate exceeding the plan rate of a comparable HIPIOWA plan.
4. Other involuntary termination (other than non-payment)

MEDICAL CONDITION

If you have been a legal resident of the State of Iowa for the past 60 days and you suffer from one of the following, you are eligible under the Medical Condition.

• Acquired Immune Deficiency Syndrome (AIDS)
• Angina Pectoris
• Arteriosclerosis Obliterans
• Artificial Heart Valve
• Ascite
• Cardiomyopathy
• Chemical Dependency
• Cirrhosis of the Liver
• Coronary Insufficiency
• Coronary Occlusion
• Cystic Fibrosis
• Dermatomyositis
• Friedrich's Disease
• Huntington's Disease
• Hydrocephalus
• Intermittent Claudication
• Juvenile Diabetes
• Kidney Failure requiring dialysis
• Lead Poisoning with Cerebral Involvement
• Leukemia
• Lupus
• Malignant Tumor (if treated or has occurred within last four years)
• Metastatic Cancer
• Motor or Sensory Aphasia
• Multiple or Disseminated Sclerosis
• Muscular Atrophy or Dystrophy
• Myasthenia Gravis
• Myotonia
• Open Heart Surgery
• Paraplegia or Quadriplegia
• Parkinson's Disease
• Peripheral Arteriosclerosis (if treatment within last three years)
• Polyarteritis (periarteritis nodosa)
• Postero-lateraol Sclerosis
• Psychotic Disorders
• Silicosis
• Splenic Anemia (True Banti's Syndrome)
• Still's Disease
• Stroke
• Syringomyelia Tabes Dorsalis (locomotor ataxia)
• Topectomy and Lobotomy
• Wilson's Disease

FEDERAL ELIGIBILITY

1. HIPAA Eligible Individual--You must be defined as an "Eligible Individual" according to the Health Insurance Portability and Accountability Act, meaning that you:
   1. Must have had 18 months or more of creditable coverage without a break of 63 full days prior to applying for this plan;
   2. Must have had the most recent prior creditable coverage under a group health plan, governmental plan or church plan (or under health insurance coverage offered in connection with such a plan);
   3. May not be eligible for a group health plan;
   4. May not be eligible for Medicare or Medicaid;
   5. May not have lost the most recent coverage because of fraud or non-payment of premiums;
   6. If offered COBRA or a similar state program, must elect and exhaust such coverage
2. Federal Trade Act Eligible Individual
   1. Must be able to provide supporting documentation of eligibility.

BASIC AND STANDARD ELIGIBILITY

You are eligible if you are a current Basic and Standard Policy Holder.

NOT ELIGIBLE FOR HIPIOWA COVERAGE

You are not eligible if you meet any of the criteria listed below:

1. You are not a resident of the State of Iowa.
2. You have terminated coverage in HIPIOWA within the last 12 months, unless you can show continuous other coverage which has been involuntarily terminated for any reason other than nonpayment of premiums; (This does not apply to HIPAA Eligible or TAA Eligible Individuals)
3. You are an inmate of a public institution; (This does not apply to HIPAA Eligible or TAA Eligible Individuals)
4. You have been paid the maximum allowable benefits payable under this program: or
5. You are eligible for a group plan through an employer;
6. You are eligible for public programs for which the individual premiums are paid for or reimbursed under any government sponsored program or by any government agency or health care provider.