Click here to download and print PCIP Application
**Updated August 2, 2010**
SCROLL DOWN FOR UPDATED PCIP BENEFIT INFORMATION
For more information, visit the official PCIP page at www.PCIP.gov
PCIP
In March of 2010, Congress passed and President Obama signed the Affordable Care
Act—the new health insurance law. The law creates a new program – the Pre-Existing
Condition Insurance Plan -- to make health insurance available to you if you have
been denied coverage by private insurance companies because of a pre-existing condition.
The Pre-Existing Condition Insurance Plan (PCIP), which is administered by either
your state or the U.S. Department of Health and Human Services, will provide a new
health coverage option for you if you have been uninsured for at least six months,
you have a pre-existing condition or have been denied health coverage because of
your health condition, and are a U.S. citizen or are residing here legally.
If you’ve been locked out of the insurance market, this program may be
able to help you through 2014. In 2014, you will have access to
affordable health insurance choices through a new competitive
marketplace called an Exchange and you will no longer be discriminated
against based on a pre-existing condition.
The Pre-Existing Condition Insurance Plan will be available in every state—but the
program may vary depending on your state. For years, many states have run programs
– often called “high risk pools” – to offer insurance if you have a pre-existing
condition. To build on what states are already doing, states can either run the
new program with resources made available by the Affordable Care Act, or rely on
the U.S. Department of Health and Human Services to provide coverage.
The Program:
- Will cover a broad range of health benefits, including primary and specialty care,
hospital care, and prescription drugs. All covered benefits are available to you,
even to treat a pre-existing condition.
- Won’t charge you a higher premium just because of your medical condition.
- Doesn’t base eligibility on income.
The U.S. Department of Health and Human Services, with the help of the U.S. Office
of Personnel Management and the U.S. Department of Agriculture’s National Finance
Center, will run the Pre-Existing Condition Insurance Plan in some states. The federal
government is contracting with a national insurance plan to administer benefits
in those states. Other states have requested that they run the program themselves.
The program may vary depending on what state you live in.
The Pre-Existing Condition Insurance Plan was created to make health
insurance available to you if you have had a problem getting insurance
due to a pre-existing condition.
The Pre-Existing Condition
Insurance Plan:
- Will cover a broad range of health benefits, including primary and specialty care,
hospital care, and prescription drugs.
- Doesn’t charge you a higher premium just because of your medical condition.
- Doesn’t base eligibility on income
The PCIP is run by the U.S. Department of Health and Human Services in South Carolina.
How to Apply in States Where the Pre-Existing Condition Insurance Plan is Run by the U.S. Department of Health and Human Services:
Download and print an application. OR, you can call 1-866-717-5826 (TTY 1-866-561-1604) and ask for an application.
To apply, you will need at a minimum:
- A completed and signed application form.
- A copy of a letter dated within 6-months of your application from an insurance company or health plan showing that you have been completely denied individual coverage because of a pre-existing condition, or you were offered coverage but were denied certain benefits (for example, by a rider to an insurance policy) because of a pre-existing condition.
ELIGIBILITY
There are a few requirements to meet before you can enroll in the Pre-Existing Condition
Insurance Plan – regardless of whether your program is run by the U.S. Department
of Health and Human Services or your state. Applicants must:
- Be a citizen or national of the United States or lawfully present in the United
States.
- Have been uninsured for at least the last six months.
- Have had a problem getting insurance due to a pre-existing condition.
PRE-EXISTING CONDITION INSURANCE POOL (PCIP) PLAN PREMIUM AND BENEFITS
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.
Age Premium
00-34 $301
35-44 $361
45-54 $462
55+ $642
In addition to your monthly premium, you will pay other costs. You will pay a $2,500 deductible for covered benefits (except for preventive services) before the plan starts to pay. After you pay the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most prescription drugs, and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.
PREMIUM INFORMATION
While you can apply for the PCIP in South Carolina today, the premium
rates won’t be officially available until July 15. The estimated
premium for a 50 year old will be between $459.00 and $561.00 in South
Carolina. If you apply before July 15, you will be notified by mail of
the premium once your application is approved. In order for your
coverage to be effective, you’ll then send in your payment.
Click here to download and print the PCIP Application
All Applications should be mailed to:
National Finance Center
Pre-Existing Condition Insurance Plan
P.O. Box 60017
New Orleans, LA 70160-0017
for more information, visit the official PCIP page at www.PCIP.gov