Healthcare Reform Update: The Pre-Existing Condition Insurance Plan
New Changes to Pre-Existing Condition Insurance Plan Effective July 1

New eligibility standards and lower premiums in some states, announced by the Department of Health and Human Services on May 31, will now make the Pre-Existing Condition Insurance Plan, created by the Affordable Care Act, available to many more Americans.

The Pre-Existing Condition Insurance Plan provides comprehensive coverage at the same price that healthy people pay. Enrollees receive primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care

The changes to the plan include:

Reduced Premiums: Premium prices were reduced up to 40% in some states effective July 1, 2011. Please visit www.pcip.gov and go to “State Plans” and click on your state of residence to see the current rates.

Simplifying Eligibility: Starting July 1, 2011, people applying for coverage in the federally-administered PCIP can demonstrate eligibility for PCIP simply by providing a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating s/he has or, at any time in the past, had a medical condition, disability, or illness. This option became available to children under age 19 in February, and we are extending this pathway to all applicants regardless of age. In addition, a person applying for coverage must be a U.S. citizen or reside in the U.S. legally and have been without health coverage for at least 6 months.

Partnering with Agents and Brokers: Beginning this fall HHS will begin reimbursing agents and brokers for referrals to the PCIP program. This step will help reach those who are eligible but un-enrolled.

 

The program provides comprehensive coverage at the same price that healthy people pay and is already changing—and saving—lives. Enrollees receive primary and specialty care, hospital care, prescription drugs, home health and hospice care, skilled nursing care, preventive health and maternity care.

To qualify for this program, a person applying for coverage must: be a U.S. citizen or residing here legally; have been without health coverage for at least 6 months before applying; and have a pre-existing condition or have been denied health coverage because of a health condition. Eligibility is not based on income and enrollees are not charged a higher premium because of a medical condition.

If you know someone who you think might qualify for this program—available until 2014—please tell them to go to www.pcip.gov for more information or call a toll-free line at: 1-866-717-5826 (TTY 1-866-561-1604). The Call Center is open from 8 AM to 11 PM Eastern Time.

 

Here’s what you can do to help this program help those who need it:

  • Ask your friends, clients or patients to find out how the program works—what  benefits it offers, how much it costs, how to qualify for the program, and how to apply. They can visit www.pcip.gov and select “Find Your State.” Individuals can select their state from a drop down menu to get program specifics. In addition, a Call Center is open Monday-Friday from 8 a.m. to 11 p.m. at: 1-866-717-5826 (TTY: 1-866-561-1604). (Information on new program changes is available at www.healthcare.gov/news/factsheets/pcip.)

 

 

  • Include a PCIP drop-in article in the next issue of your newsletter. Please drop a note to laurie.oseran@hhs.gov for a copy of a PCIP newsletter article.

 

  • Include a PCIP speaker on your next webinar, conference call, and state or national meeting. Experts from our National Speaker Bureau can tell your colleagues and members everything they need to know about the Pre-Existing Condition Insurance Plan. Our speaking staff includes health insurance experts such as Jay Angoff (Senior Adviser to Secretary Sebelius), Richard Popper (Director, PCIP), and other program experts. To find out how to arrange a speaker for your next event, please contact: Laurie Oseran at laurie.oseran@hhs.gov.

 

 

For more information about Healthcare Reform, you can go to www.healthcare.gov

HDSA thanks the American Heart Association for sharing this update.