Eligibility for Pre-Existing Condition Insurance Plan or PCIP

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Published: 17th June 2015
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The Department of Health and Human Services and the government have devised a plan for individuals with pre-existing condition known as Pre-Existing Condition Insurance Plan or PCIP to provide them health coverage. It offers health insurance coverage to those individuals who have been without coverage for at least 6 months because of a pre-existing condition. New enrolment in the Pre-Existing Condition Insurance Plan or PCIP has been suspended on 16 February 2013 till further notice. It currently covers more than 100,000 people.

Eligibility Criteria for Enrolment in PCIP

To be eligible for enrolment in Pre-Existing Condition Insurance Plan or PCIP an applicant must fulfil following criteria:-

The applicant must have a pre-existing condition.
He should be a U.S. citizen or a legal resident of the U.S.A.
The applicant must have been without health coverage for the last 6 months due to pre-existing condition.
Documents Needed to Support Eligibility for PCIP

While applying for a federally-run PCIP, an applicant needs to provide one of following document to show his eligibility.

A letter of denial from an insurance company for individual insurance coverage dated within the past 12 months. One can also produce a letter dated in the past 12 months from an insurance agent or broker licensed in the state of residence showing ineligibility of the applicant for individual insurance coverage from one or more insurance companies because of ones medical condition instead of the letter from insurance company. The denial letter from the insurance company must include name of the applicant, name of the licensed insurance company on official letterhead and a statement of ineligibility due to pre-existing condition. The letter from broker or agent should include name of the applicant, name and business address of the agent or brokerís insurance agency, agent or brokerís state producer license number, name of at least one insurance company that has, or would have, denied health coverage to the applicant due to a pre-existing medical condition and statement of ineligibility for the insurance companyís coverage due to pre-existing condition.
An offer of individual insurance coverage excluding health insurance offered through a job, dated within the past 12 months rejected by the applicant because it didnít cover his medical condition. This offer of coverage should clearly show that it the applicantís medical condition wonít be covered in case he buys the plan. It should include applicantís name, name of the insurance company on official letterhead, a rider with an effective date, and a date when it expires or can be removed and a statement that the rider wonít cover applicantís specific medical condition.
For individuals under 19 a letter from a doctor, physician assistant or nurse practitioner dated within the past 12 months stating the name and current or past medical condition, disability, or illness. This letter must also have name of the medical practitioner, state of licensure and license number and original signature.
Individuals under age 19 can also produce a letter of an offer of individual insurance coverage excluding health insurance offered through a job, dated within the past 12 months, which was denied by him due to too high premium. This offer of coverage must show a premium at least twice as much as the PCIP premium. The letter should include applicantís name and a statement that includes the premium for the coverage being offered, but not accepted.
Who Are Not Eligible for PCIP Coverage

In following cases an individual is not eligible for enrolment in Pre-Existing Insurance Plan or PCIP.

If he has other insurance coverage, even if it doesnít cover his medical condition.
If he is enrolled in a state high risk pool.
He has any of Medicare, Medicaid, CHIP, VA or TRICARE coverage.
If he has any job-based coverage, including COBRA, or continuation of coverage, in case itís running.
If he has a limited benefit plan.

For more information visit: http://www.unsafedrugs.com/eligibility-pre-existing-condition-insurance-plan/

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