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PRE-EXISTING CONDITION INSURANCE PLAN (PCIP)
WHAT IS THE PRE-EXISTING CONDITION INSURANCE PLAN?
The Pre-existing Condition Insurance Plan was created as part of the HealthCare Reform Act, otherwise known as the Affordable Care Act. The PCIP program was originally designed to make health insurance available to those who have been denied coverage by private insurance companies because of a health condition. However, it has recently been change so you no longer need to actually have been denied coverage, you just have to have a pre-existing health condition.
Additional requirements are you must have been uninsured for at least six months and you are a U.S. citizen or are residing here legally. The plan is currently expected to terminate in January 2014.
WHAT IS A PRE-EXISTING CONDITION, OR "IS MY CONDITION ELIGIBLE?"
You must have a pre-existing condition. To prove this, you will be asked as part of the application process to submit one of the following documents dated within the past 12 months:
- A letter from a doctor, physician assistant or nurse practitioner stating that you have or had a medical condition, disability or illness. This letter must include your name and medical condition, disability or illness, and the name, license number, state of licensure and signature of the doctor, physician assistant or nurse practitioner.
- A denial letter from an insurance company licensed in your state for individual insurance coverage. Or you may provide a letter from an insurance agent or broker licensed in your state that shows you aren't eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
- An offer of individual insurance coverage that you did not accept from an insurance company licensed in your state for individual insurance coverage. This offer of coverage has a rider that says your medical condition won't be covered if you accept the offer.
For children under age 19 or for people who live in Massachusetts or Vermont you must have been quoted a premium of 200% or more of the PCIP premium for the Standard Option in your state.
PREMIUMS
Premiums will vary by state. Here are the 2011 monthly PCIP premium rates for Arizona by age of enrollee, effective July 1, 2011:
|
Age |
Standard Option |
Extended Option |
HSA Option |
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0 to 18 |
$104 |
$141 |
$109 |
|
19 to 34 |
$157 |
$211 |
$163 |
|
35 to 44 |
$188 |
$253 |
$195 |
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45 to 54 |
$240 |
$324 |
$250 |
|
55+ |
$334 |
$450 |
$347 |
Go here to see the summary of benefits for Arizona and the other states shown below in green.
WHERE DO I GET MORE INFORMATION AND HOW DO I APPLY?
If you are an Arizona resident we will help you enroll. Contact us for more information. Otherwise, in the green states on the map you can go to PCIP premium rates and see the PCIP benefits. For all other states you'll need to go HERE.
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