Pre-Existing Condition Insurance Plan (PCIP)

How do I apply for the Pre-Existing Condition Insurance Plan?

Go to https://www.pcip.gov/ to apply.

What is a pre-existing condition?

A pre-existing condition is a condition, disability or illness (either physical or mental) that you have before you enrolled in a health plan.

Will the Pre-Existing Condition Insurance Plan (PCIP) be available in every state?

Yes, every state has a plan that offers comprehensive health coverage for uninsured Americans with pre-existing conditions. The program name and other plan details vary depending on which state you live in and whether the program is run by the state or the Department of Health and Human Services.

When will my coverage be effective?

If you are eligible, your coverage start date depends on when the Pre-Existing Condition Insurance Plan receives your completed application and all required documents. Generally, a completed application received on or before the 15th of the month will go into effect on the first day of the next month. A completed application received after the 15th of the month will go into effect on the first day of the following month.

May I apply for the Pre-Existing Condition Insurance Plan if I have existing health coverage?

You are not eligible unless you have been without health coverage for at least the last 6 months. For example, if you have Medicare or TRICARE, you shouldn't apply. Also, if you have coverage provided by a state high risk pool or insurance coverage that may not cover a pre-existing medical condition, you shouldn't apply. If you are uninsured and have been told that you may be eligible for other coverage programs like Medicaid and the Children's Health Insurance Program, you should check out those programs first, as they may better meet your needs. If you have job-based coverage, or individual insurance coverage, you aren't eligible to apply.

May I apply for the Pre-Existing Condition Insurance Plan if I have COBRA or other continuation of coverage?

No, even if your COBRA or other continuation of coverage is about to run out, you won't be eligible until you have been uninsured for at least the last 6 months, and meet other eligibility criteria.

I currently have insurance that excludes coverage for my pre-existing condition. Am I eligible for this program?

No. To be eligible for the Pre-Existing Condition Insurance Plan, you must have been without other health coverage for at least 6 months from the date of application.

What health care providers are in the network?

The Pre-Existing Condition Insurance Plan will have provider networks that include a full range of services and specialists. You can search for participating providers at www.PCIPlan.com.

Is there a cost for this coverage?

If you are eligible for the Pre-Existing Condition Insurance Plan, you pay a monthly premium for your coverage.

What do I do if I can't afford these premiums?

If you have limited income and resources, you may be eligible for the Medicaid program in your state. If you are seeking insurance coverage for your child, go to www.insurekidsnow.gov to learn more about children's health insurance in your state.

What is going to happen to my PCIP coverage when the program ends in 2014?

The Pre-Existing Condition Insurance Plan is a transitional program that provides health coverage to people with pre-existing conditions. This program is available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. If you are enrolled in PCIP, we will provide additional information about how your Pre-Existing Condition Insurance Plan coverage will change and how you can take advantage of the new coverage options available in 2014.

How does the pending lawsuit against/legislation repealing the Affordable Care Act affect my PCIP coverage?

The Affordable Care Act remains the law of the land and we are continuing to carefully and effectively implement this law to improve the health of all Americans. The Affordable Care Act created the Pre-Existing Condition Insurance Plan, which is available to people who are U.S. citizens or residing here legally, have a pre-existing condition or have been denied health coverage because of their health condition, and have been without health coverage for at least 6 months. This program will be available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. We recognize how important the Pre-Existing Condition Insurance Plan is to you and will let you know if there are any changes that could affect your coverage.

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