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Home arrow Resources arrow Articles arrow What is the Pre-Existing Condition Insurance Plan?

What is the Pre-Existing Condition Insurance Plan?

Health insurance is often on the forefront of every individual's mind. This is particularly the case if you lost your job or you work for yourself. People who are lucky enough to receive employer-mandated health insurance don't have to worry about qualifying for insurance because typically, situations like pre-existing conditions don't affect their ability to receive insurance.

However for everyone else who purchases their own private insurance plan, there can be more to tend with when being eligible for insurance. Many insurance plans require the individual to meet their eligibility requirements, which often means not having a certain type of pre-existing condition such as certain illnesses or disabilities. If this applies to you, you may have discovered how difficult it is to be approved for private health insurance; however ,an insurance plan called the Pre-Existing Condition Insurance Plan exists that can provide coverage until the future Affordable Care Act goes into effect.


What is PCIP?

The Pre-Existing Condition Insurance Plan, also known as PCIP, is a unique insurance plan that provides coverage to individuals residing in the United States who have been denied coverage by other insurance companies as a result of a pre-existing or previous health condition, such as a severe illness or disability. The upcoming Affordable Care Act will offer health insurance to a broader selection of Americans, but it does not go into effect until 2014. Until then, individuals are able to receive pertinent health insurance coverage through the pre-existing condition insurance plan.

What Constitutes Pre-Existing (Previous) Conditions?

A pre-existing or previously existing condition is typically an illness, disability or mental or physical condition that someone has before they enroll in a healthcare plan. Each individual state and private insurance company will have their own set of conditions that may prevent eligibility to enroll in healthcare insurance, ranging from diabetes and cancer, to milder conditions like obesity and high blood pressure. Most commonly, pre-existing conditions are those which the insurance company deems to require a high amount of medical cost associated with treating it, which includes expenses related to doctor visits, laboratory testing, hospital stays, medical procedures, or surgeries, and medications.

Who is PCIP Eligible?

In order to have eligibility to enroll in PCIP, the individual must meet certain requirements, such as being uninsured for a period of at least six months along with being a U.S. citizen or a legal resident. Other eligibility requirements include having a pre-existing or previous medical condition, being denied coverage for pre-existing conditions, or for individuals who have been approved for insurance coverage but with limitations as a result of their disability, illness, or medical condition. However, individuals who have a healthcare plan that excludes coverage for the condition are not eligible because they must have been completely uninsured for six months.

How to Apply?

The PCIP.gov website has a detailed list of eligibility requirements and instructions on how to apply for Pre-Existing Condition Insurance Plans. Typically, the process involves looking over the requirements for your state and filling out an application. You must live in one of the 23 states that allow the federal government to administer their programs or one of the 27 states that choose to run programs on their own.

Are There Any Exceptions?

As with most insurance plans, there are some exceptions for eligibility for PCIP. Individuals, who are currently insured, even if the plan excludes their pre-existing condition, will not be able to enroll in the PCIP due to the requirement of being uninsured for six months or longer. Additionally, individuals who have previously lost their job and regular health insurance but are receiving COBRA supplemental insurance, which continues their insurance coverage, are also not eligible for this program. Some states also have further exceptions such as specific pre-existing conditions that will not be allowed for this type of insurance coverage.

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