Federal Insurance Plan Provides Coverage for Pre-Existing Conditions August 26, 2011 Health Care Reform, News Affordable Care Act, HHS, insurance, PCIP 0 Under the Affordable Care Act (ACA), uninsured children and adults who have pre-existing health conditions can secure comprehensive health care coverage through the Pre-Existing Condition Insurance Plan (PCIP) until the new insurance market rules take effect in 2014. At that time, PCIP enrollees will transition to the health insurance exchanges that will be established in every state. Last month, the Department of Health and Human Services (HHS) outlined more flexible steps that physicians can take to help PCIP applicants secure coverage in states where the federal government administers the plan. Previously, applicants had to provide a denial letter from an insurance company to prove they had a pre-existing condition. Now physicians can supply PCIP applicants with a letter stating that the applicant either currently has a medical condition, disability or illness, or that the applicant had one within the last 12 months. This is a major step toward ensuring that patients get the care they need. HHS has provided a simple template letter that physicians can use. To be eligible for the PCIP, the applicant must be a U.S. citizen or reside in the country legally. In addition, the applicant must have been without health insurance coverage for at least six months before applying. Finally, the applicant must have a pre-existing condition or have been denied coverage because of his or her health. Eligibility for the program is not income-based. For applicants who are accepted into the PCIP, all benefits—including those related to pre-existing condition treatments—are effective upon the date of coverage. The benefits include primary and specialty care as well as hospital care and prescription drugs. Enrollees in the PCIP should not have to pay a higher premium due to a medical condition. According to HHS, many PCIP enrollees will pay significantly lower premiums than they would have paid for coverage available to them in the general insurance market. Visit the California PCIP website to learn more about PCIP eligibility. The toll-free PCIP call center is (877) 428-5060; hours are 8 am to 8 pm Monday to Friday, and 8 am to 5 pm on Saturday. Comments are closed.
