PCIP FREQUENTLY ASKED QUESTIONS
What is The (PCIP) Pre-Existing Condition Insurance Plan?
PCIP was developed as part of the Affordable Care Act. This program makes insurance available to people with pre existing conditions who have been uninsured for at least six months and are unable to obtain health insurance due to their pre-existing condition. The program is available to U.S. citizens and people residing in the U.S. legally. The plan will be available until 2014 when insurance exchanges are in place at which time no one with a pre-existing condition will be denied or declined coverage.
Will my PCIP change when the program is no longer available in 2014?
A Health Insurance Exchange will be available in 2014 which will provide individuals and business with affordable insurance options. There will be different options for different benefits and prices. Once 2014 is here, it will be against the law for any insurance company to deny you based on your pre existing condition. If there are any changes to take place on your PCIP when 2014 arrives you would be notified.
Will the disputes with legislation against the Affordable Care Act have any effect on my PCIP Plan?
The Affordable Healthcare act is the law and we will be sure to contact all members if any changes are to be made to the law or if any guidelines rules regulations or other are put in place. As of current, pcip programs are available.
Where do the funds for the PCIP come from?
All funds are from the federal government. $5 billion was allocated for the nationwide program.
What benefits are included for the members?
All GEHA states will offer the same benefits. There are three plans available in the GEHA states that prospective member could choose from. These plans have deductibles and annual out-of-pocket expenses. What this means to a member is there will be liable for healthcare costs up to a specified maximum. Once the specified maximum has been reached the Pre-existing Condition Insurance Plan program will pay for benefits in it’s entirety.
The member benefits include hospital stays, prescription medication an physician visits. If in network physicians are utilized the benefit would be better for the member. There are no waiting periods for treatment and pre existing conditions are included.
What happens to prospective members who are currently in a high risk pool?
The PCIP plan will not affect anyone who is currently in a high risk pool. Thirty-four states have a high risk pool and those members will keep the coverage they have.
Will I be able to put my family members on my PCIP plan?
No. The PCIP plan is for individuals and each member will have to obtain their own plan.
What does GEHA stand for, and who are they?
GEHA stands for Government Employee Health Association which at this time works with the federal government and offers dental and health to retirees and civilian federal staff. This was once a plan for railway mail clerks over seventy years ago. The GEHA now offers health benefits for over one million people throughout. GEHA is a non profit organization located in Kansas City, Mo.
What is the definition of a pre existing condition?
Any condition you may have, for example physical or mental illness, disease or disability that you were diagnosed with prior to enrolling in a health insurance plan. The plan was created as last resort for people with conditions that could not otherwise obtain coverage from private carriers.
What if I have a condition that is not considered to be very bad condition and private carriers may cover, can I still get coverage from the pre-existing condition health insurance plan?
Certainly you can Register as long as you do meet the very short eligibility requirements, however the ultimate decision on acceptance is made by the National Finance Center (division of U.S. Department of Agriculture).
Is the PCIP plan available throughout the US?
All states do offer plans for people with pre existing conditions. The names of the plans and the benefits offered differ by state and also differ based on whether the plan is controlled by the state or the Department of Health and Human Services. To see more about the PCIP plans available in different states please click on the following link to see the plans available in your state State plans page.
When will my PCIP plan become effective?
If your application along with all required documents are received by the 15th of the month, your PCIP plan will be in force by the first of the following month. If your PCIP application is received after the 15th and before the last day of the month, your insurance will be effective on the first day of the second month. Upon approval of your application you will be advised how to select an earlier effective date. Effective dates will always be the first of any month and ceratin circumstances Pre-existing condition insurance applications may be expedited.
If I currently have health insurance can I still register for a PCIP plan?
Eligible applicants must be without insurance for at least six months before submitting an application. If you currently have TRICARE or Medicare you would not be eligible for PCIP insurance. In addition, if you are currently in a state high risk pool or you have insurance that put a rider on your pre existing condition you would not be eligible for PCIP insurance. If you have insurance through your place of employment or an individual policy you would not be eligible as well. If you are currently uninsured but have been advised you potentially may be eligible for the CHIP program (Children’s Health Insurance Program) or Medicaid you should review those programs and see if they better meet your current insurance needs.
Am I eligible for PCIP if I am currently on COBRA or a similar program for continuing benefits?
You would not be eligible for PCIP unless you have been uninsured for at least six months. If you question whether your insurance coverage is considered real health insurance fill out the contact form to have a representative contact you.
I am currently insured but the current insurance I have will not cover my pre existing condition. Am I still eligible for the PCIP plan?
You would not be eligible for a PCIP plan unless you have been uninsured for at least six months. If you have applied for private medical insurance and the carrier has ridered out the condition for coverage you would be eligible for the pre-existing condition plan if you choose not to accept the health insurance offered from the private carrier and have not had coverage for six months prior.
What is the PCIP plan network of providers?
The PCIP plan has networks that have a wide array of specialists and services. It is important that you stay in your network and choose doctors, surgeons, hopsitals and any providers in-network. The search can be done for geographic location or a specified hospital or physicians specific name.You can view the list of providers by viewing the PCIP Networks tab in the main menu bar at top of this page.
What is the fee for the PCIP plan?
If you are eligible for the PCIP plan you will pay a monthly premium for your insurance. To view a list of PCIP plan rates please visit the following link State Plans.
What can I do if the premium is out of my budget?
If you are on a limited income you could register for Medicaid in your state. If the insurance you are looking for is for a child please visit the following link www.insurekidsnow.gov. This link will provide you with the information on health insurance for children in your state..
Will the current lawsuits against the Department of Health and Human Services regarding the Affordable Health Act have any affect on my PCIP plan?
The affordable Healthcare Act is the law and is continually tries to improve the health of US citizens or those who are here legally. The PCIP plan was created by the Affordable Care Act and has been made available to all US citizens and people who are in the US legally and who have a pre existing and have been denied coverage due to their pre existing condition. All applicants must be uninsured for at least six months prior to submitting their PCIP application. The PCIP plan will be available until 2014, at that time you will still have access to affordable health insurance but you will access it through and insurance exchange. The insurance exchange will offer affordable insurance to small businesses and individuals. The exchanges will offer different options and premiums to help meet your insurance needs. Also, come 2014 it will be illegal for any insurance company to deny a person due to their pre existing condition. If there are going to be any changes made to the PCIP plan we will keep you informed.
Will I be informed if my rates change?
If you are currently enrolled in a PCIP plan a letter will be mailed starting the beginning of June 2011. The letter will include the new premium amount that will go into effect July 1, 2011. The letter will also have instructions on what to do if you have pre paid your monthly premiums and require some type of credit. To view a list of the premiums that are effective as of July 1, 2011 please click on the following link State Plans and then select your state.
Will there be any additional changes made to my PCIP plan?
There will be no additional changes made. You will still have the same three benefit options: Standard Plan, Extended Plan and HSA Plan. Your benefits will remain the same and your co pays will remain the same.
Am I able to switch plans?
Once you have selected a plan you are unable to switch. Regardless of the selected plan, if you live in a state that just had a premium adjustment you will still see that reflected in your monthly premium.
If I pre paid my premiums will I receive a refund?
If you pre paid your PCIP insurance premium and your state was one that received a rate decrease you will receive a credit of what you have now paid over toward future payments.
Why did PCIP have a rate change?
PCIP made premium changes to best suit individuals who are able to be accepted into the PCIP program. Prices are such that are reasonable and customary to what a healthy individual might pay for major medical of his or her age in that respective state. This makes it more affordable for those with a pre-existing condition to get insurance coverage at an affordable rate, deductible etc.
Why is it all PCIP members did not have a change in their monthly premium?
All PCIP premiums differ by state. The individual market for health insurance varies state to state. Many on the Federal level have been given credit and State insurance while follow many of the same path, opporate on their own guidelines for many areas.
The Federal or State PCIP insurance what is the difference?
PCIP is pre existing condition insurance plan. It will cover your pre-existing condition from you first day of coverage. There is no waiting period. The PCIP plan is offered through the Department of Health and Human Services and the Government Employees Health Association GEHA.
The plan is offered in 23 states plus the District of Columbia. The other 27 states are individually run seperate by each state as they had a choice to do once the law was passed in 2010. The Federal is administered by HHS and the NFC a department of the U.S. Department of Agriculture processes apps and payments.The plans that are handled by these groups are federal and all the plans are the same in coverage. State plans will vary in coverage.
Does the PCIP plan have deductibles?
Yes, the PCIP plan does have deductibles. Thankfully deductibles for the pre-existing condition insurance plans are typically the same or smaller than that of the private major medical comprehensive plans.
Deductibles vary on the federal states depepending on the three plan options either $1,000 deductible, $2,000 deductible or max of $2,500-$3,000 deductible on the HSA plan. Some associations and guaranteed issue insurance have plans that do not have deductibles but you do have to consider what is offered without the deductible. No deductible does not mean better coverage. Pcip offers best of both worlds by covering comprehensive and catastrophic and being robust in benefits combined with affordability and coverage from day one there is no plan to compare better for any person with pre-existing conditions not accepted by major medical
What plan options are there and the differences?
The Standard option plan is most popular and most affordable and has a $2,000 deductible standard on all Federal pcip benefits.
The Extended plan on the federal level (check the state list) has a slightly higher premium and as such as a lower by comparison deductible set at $1,000 dollars. This is the next highest chosen plan of the three offered.
The HSA or Health Savings Account has a higher deductible but the benefit is that the drug prescription medications do not have a seperate deductible. Once satisfying the deductible for the calander year you are covered.
What are the premiums for members?
The premiums vary by state and by which plan you choose to enroll in. Please follow this link for GEHA states RATE per your state.
What medical centers and physicians are covered with this plan?
All members will have access to PCIP provider network. Staying in-network will provide more coverage to you since providers, hospitals, physicians and so forth have agreed to be a part of the network and provide the same service. See the network menu tab for a list of network providers to see if your medical professional or entity such asa hospital is listed.
How do I become a member?
If the PCIP in your sate is through the federal government (GEHA) you can access the application by clicking on the application or register now tab within this site. They will provide you with an application. Or contact the Insurance Resource Center by going to contact tab or calling 866-666-Insure(4678).
Is the PCIP in the state I am in through the federal government?
Please click the following link map of the PCIP states to see a list of states run by the GEHA.
Option To Those That Do Not Qualify For Pre Existing Condition Insurance Under Government?
IThere are many agents and agencies that do provide a guaranteed issue type insurance product in their portfolio for you however the differences are dramatic. Nearly every plan is an association plan you will need to join to have access to the groups health insurance plan it would be necessary. Once in a group you can not be turned down for medical conditions. HOWEVER, most plans are extremely limited in coverage. It is the main reason the name is called Limited medical benefit plan or defined benefit plan or even mini medical. There is typically a cap on coverage for a specified medical treatment or doctor visits, surgery, and more. It does provide insurance and access to the health care system via the network for a reduced pricing and that is important. This should only be an option if PCIP insurance or pre-existing condition insurance is not available in your state through a risk pool or if you can not afford the rate of a risk pool and would go without coverage. Also if you were deemed not eligible for coverage for pcip if you had coverage in the last six (6) months and do not wish to go without coverage the non state or non federal plan would then be a last option. View plans for the Pre existing condition insurance
by visiting www.Pre-existingConditionInsurance.com
Can I Regsiter for PCIP Coverage If I Have Another Insurance?
Please see answers below. If No you must be free from having that coverage for a certain amount of time prior to registering (at least 6 months)
If you have:
Workmans compensation yes
Liability insurance yes
Ancillary product such as A.D&D (accidental death and dismemberment) Yes
Medicare (part A and or B) No
Short term health insurance or temporary insurance No
Major Medical No
Limited Medical benefit plans/Mini medical/ Indemnity plan -Possible depending on plan(send in for review or contact us at the Insurance Resource Center. If do not qualify please see "
Option To Those That Do Not Qualify For Pre Existing Condition Insurance Under Government?", located above.