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White House Relaxes PCIP Requirements to Kick-Start Enrollments

Margaret Dick Tocknell, for HealthLeaders Media, June 1, 2011

With enrollment in the Pre-Existing Condition Insurance Plan lagging well behind original estimates, the Obama administration Tuesday announced steps to lower premiums and increase enrollment in the high-risk insurance plans. And, to generate program interest among agents and brokers, payments will be made for successfully connecting eligible people with PCIPs.

Effective July 1, premium costs for the Pre-Existing Condition Insurance Plan will drop by between 2% and 40% in the 23 states and the District of Columbia where the PCIP program is federally administered. In addition, to qualify for the program applicants will only need to produce a physician's letter dated within the past 12 months, stating that the applicant has had a medical condition, disability or illness.

Applicants still need to have been uninsured for six months. Previously, applicants for the PCIP program needed a letter of coverage denial from an insurance company in addition to having been uninsured for six months.

When the $5 billion PCIP program was introduced in 2010 it was envisioned as a stop-gap measure to provide people with pre-existing conditions with access to affordable health insurance.  Those people are often rejected by health plans.  The temporary program will exist only until 2014 when insurers will no longer be able to deny coverage to people with pre-existing conditions.

The Congressional Budget Office estimated that about four million uninsured would be eligible for the $5 billion program and that 200,000 would be enrolled by 2013.

Instead, PCIPs had attracted only 18,313 enrollees as of March 31, 2011, according to the Department of Health and Human Services.

The goal of the premium reduction is to bring PCIP costs in line with private individual insurance. In Florida, state officials expect the premium reductions to attract new interest in the PCIPs. "We have a significant population on fixed incomes," explained Jerome Ashford, executive director of the Florida Comprehensive Health Association, which is responsible for the state's high-risk insurance program. That program has been closed to new enrollees since 1992.

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1 comments on "White House Relaxes PCIP Requirements"


mitchell2u (6/14/2011 at 5:19 AM)
Today we received our denial for health insurance due to a pre-existing condition. The requirements for a possible re-application are to be "symptom and treatment-free for 3-5 years." This is impossible. Attached to the letter was a page discussing appeal rights, blah, blah, blah...and at the very bottom was a mention of PCIP and to check the website www.healthcare.gov for more information. I skeptically went to the website and within minutes found that we might actually be able to buy semi-reasonably priced health insurance with fairly decent coverage and all our doctors are on the "in-network" list. Up until today, I had no idea this program even existed and I do not live under a rock. It is a shame that this program exists without any public education and awareness. It reminds me of the Lead-Based paint law that went into effect April 2010 requiring all workers (and landlords and property managers) disturbing painted surfaces in pre-1978 homes, schools or child-care facilities to be EPA Lead-Safe Certified and pass an 8-hour training course to learn about lead-safe work practices. It's all posted on www.epa.gov/lead I bet most people don't know about that either :-(