Changes Coming to a PCIP Near You

By Jennifer Sullivan

Beginning May 1, eligibility requirements for the Pre-Existing Condition Insurance Plan (PCIP) will change in the 24 states with PCIPs administered by the Department of Health & Human Services (HHS). In order to enroll, applicants must prove that they have a pre-existing health condition with one of the following documents:

  • (1)   A denial letter from an insurance company
  • (2)   An offer of coverage from an insurance company that includes a pre-existing condition exclusion
  • (3)   A letter from a broker or agent indicating that the individual would be denied coverage

This change overrides the previous documentation rules, which only required a letter from a health care provider indicating the applicant’s health condition(s).

PCIPs run by HHS will also no longer be paying referral fees to agents and brokers for sending consumers to the PCIP.

As of February 29, 2012, 56,257 people were enrolled in PCIPs, and about 40 percent of these were in a plan administered by HHS. Although these changes might make it slightly more cumbersome for people to enroll in the plan, it remains available in all 50 states and the District of Columbia.    



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