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Pre-existing Condition Insurance Plan

PCIP refers to the Pre-existing Condition Insurance Plan, and was designed to assist those unable to obtain health insurance through their employer or in the individual market. The coverage was designed as a high risk pool, funded by a set amount of federal funds for a certain number of people. The plan was to cover people meeting stringent requirements, the most significant being they had gone without any form of health insurance for six months. Enrollment started off slowly, but soon picked up as more and more people trying and failing to obtain health insurance met the guidelines.

The Pre-Existing Condition Insurance Plan covers people regardless of their health status. Premiums are set according to age and rating areas, and cannot be rated if your condition is more severe. The benefit to the PCIP plan versus MRMIP is the fact that once the policy is in effect there are no waiting periods. To qualify you must be have a pre-existing condition rendering you ineligible for individual coverage, have gone without any insurance for at least six month, and be a U.S citizen or legal resident.

Applying for PCIP requires the following:

  • Completed PCIP application
  • Proof of a pre-existing condition, via a denial letter from an insurance carrier, a letter from the doctor in the last 12 months stating the condition
  • Proof of citizenship or legal resident documentation
  • Social Security number must be presented for all US citizens or nationals

PCIP was expected to carry Californians into 2014 when medical underwriting was no longer an issue. However, more people utilized the plan than originally expected, thus draining funding a lot earlier than expected. The last California application was submitted on March 2nd. Those that met the deadline as well as those already enrolled on the program are now required to convert to the federally-run PCIP plan no later than July 1st. Missing this date means going without coverage until January 1, 2014 so it is of utmost importance that PCIP clients make the switch.

Federally Run PCIP transition plan estimates the following premiums for individuals in 2013:

  • Age birth – 18 will be $117 per month
  • Age 19 – 34 will be $161 per month
  • Age 34 – 44 will be $287 per month
  • Age 45 – 54 will be $366 per month
  • Age 55+ will be $505 per month

For more information on the federal PCIP program please feel free to contact Health Exchange Quote Insurance Agency for more information or visit https://www.pcip.gov/ for the application.

 

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