PCIP Plans Explained
The PCIP or Preexisting condition insurance plan is a program launched from the Health Care Reform and Affordable Care Act with need brought about of tens of millions of Americans. Many individuals could not obtain coverage simply due to a pre-existing condition considered by underwriters to be a risk. If and when insurance by private carriers would accept those deemed to be a high risk by actuaries and underwriters, the risk was offset by a premium not affordable by most. Few carriers that would accept could also find cause to not cover the pre-existing condition for period of a year, or an exclusionary period. (see more info in About tab)
With the new political administration, fueled by change, the Health Care Reform took center stage, and the Affordable Care Act thereby providing coverage to all those with a pre-existing condition by January 1, 2014. In so passing the immediate solution funded by government ($5,000,000,000) to have each state provide a PCIP program to its’ residents, by opting to provide on a State level or Federal-administered level program.
If you have a pre-existing condition, the PCIP insurance plan may be for you. (see eligibility) The plan provides benefits with coverage from the first day without a waiting period. Coverage is robust in that it covers an individual without limitation once the deductible has been reached and or co-insurance (if catastrophic). There is a maximum out of pocket like most major medical with no maximum lifetime coverage. These insurance benefits mimic the coverage that a healthy person might normally pay. There is no price difference based on sex or tobacco on the Federal health isurance plan. An individual with a pre-ex is now able to receive coverage at the same rates that a healthy individual would pay and metered by the demographics of the state. On the Federal administered states, rates for the PreExisting Condition Insurance Plan is based upon state geographic location and age as well as the plan you choose.
The Following Are The Three (3) Plans Available For All PCIP Federal Health Insurance States:
Standard Option: A Fixed two thousand ($2000) dollar for staying in network or a three thousand ($3000) dollar deductible for the calendar year if out of network on medical care. There is a five hundred ($500) dollar cost for deductible to be satisfied on prescriptions that are generic or formulary or a seven hundred and fifty ($750 dollar) non formulary. This is the most popular plan however if you are intending to get benefits to cover conditions in which a deductible will have to be met the extended option may be higher, yet a better choice.
Extended Option A Fixed deductible need be satisfied with this plan on a calendar year for any medical care benefits to be paid. This slightly high premium rate plan has only a one thousand ($1000) dollar deductible or a fifteen hundred dollar if you are out of the chosen network. In addition the Rx prescription has a separate deductible which is an affordable two hundred fifty ($250) dollars for generic or three hundred and seventy five dollars for Formulary prescription drugs.
HSA Option Plan is often chosen due to the tax advantage that it qualifies for under the high deductible health saving account offers. Although the plan is higher in deductible, $2500 in network or $3000 out of network, this comprehensive plan offers a one deductible only that needs be satisfied for medical and prescriptions unlike its sister plans there is a deductible for both medical and medications to be satisfied prior to coverage. This is a great option to build savings in an account designated for it so that in the event you will need funds for the deductible you will have them already designated for you in a tax free holding.
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