Eligibility Qualification
There are some requirements that must be met before you are deemed eligible for the PCIP plan, regardless of whether the plan is run by your state or Federal United States Department of Health and Human Services (HHS) and cooperative Government Partners and contracted groups.
For Qualified PCIP Enrollees, it is required that all applicants must fall into the guidelines listed below, conversely, what to do IF NOT Eligible.
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 Be a United States citizen or national, or be residing in the US legally
You must be uninsured for at least six months prior to submitting your application. Please be aware that if you currently do have health insurance and your pre existing condition is not covered you would not be deemed eligible for the PCIP plan. You must be without creditable coverage 6 months or more.
You must have a pre existing condition and you will also be expected to provide this information along with your application.
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This information will include either, and depending on the state:
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Document in writing for your doctor’s office, a nurse practitioner or physician’s assistant documenting your medical condition, illness or disability. Patients name, medical condition, physicians name and license number with state of issue. This document must be dated within the past twelve months. Another option to avoid delay would be to contact us on our contact page and if it is a condition by which you have been declined in getting coverage in the past you may request a letter from us directly to support the application depending on state and condition.
Federal states will not need, but State plans (view state list) may require a letter of denial from an insurance company you applied to or a letter from your insurance agent/broker advising you are not eligible for insurance. This must also be dated within the past twelve months.
A letter from an insurance company which is licensed in your state that is offering you coverage but advising if you accept the policy there will be a rider (exclusion) on your current pre existing condition. In this case it would be best for you to decline that coverage and opt for the PCIP insurance as it would be more Robust in benefits for your preexisting condition beginning right away.
If you reside in Massachusetts or Vermont, and/or you are under the age of 19 and received an offer for insurance that is not employee based and is twice the premium than the PCIP plan Standard Option in your state.
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If You Are Not Eligible, perhaps you have had coverage in last 6 months or on C.O.B.R.A, contact the Insurance Resource Center directly by filling out the contact form, and let the advisor know that he or she may direct you to get coverage from a list of accepting private associations. You also may register for Medicare, Medicaid, or State Risk Pool. Non-Federal or State plans would be available online to view rates and register. The plans have no affiliation or endorsement from Federal or State agencies, however is real insurance and would provide you coverage if you can not qualify for any other plan. It is better to be with insurance and access to the healthcare system should a situation arise.
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