Pre-Existing Condition Insurance Plan Coverage

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Published: 08th April 2015
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Anyone eligible for getting health coverage through Pre-Existing Condition Insurance Plan Coverage (PCIP) can apply either online, by mail or by phone. People applying online need to fill an online application and later mail along with any required documents listed in the confirmation page within 10 days. People who intend to apply through mail need to download the enrolment application and mail the filled form along with required documents. One can also apply through phone and later mail the required documents. If someone fails to submit required document the application is considered incomplete and cancelled after 21 days. One can re-apply in case of cancellation due to incomplete application.

How the Application Process Works

After applying one gets a letter within 2–3 weeks letting him know if his application is approved. The letter contains information about monthly premium, when coverage starts and how to make first premium payment. With the payment of first premium coverage starts. In case of failure to make first payment, the PCIP is cancelled. On starting of coverage the enrolee gets PCIP ID card and can avail all covered benefits. In case an enrolee has not received insurance card and needs immediate care, he may contact PCIP benefits administrator.

When Coverage Starts

If the application and documentation are received on or before the 15th of the month, coverage will be effective the first day of the next month. But if the application and documentation are received after the 15th, coverage will be effective the first day of the second month.

What’s Covered

The PCIP covers many health benefits, including primary and specialty care, hospital care, and prescription drugs. It also provides preventive care with no deductible if a preventive diagnosis is needed. It also offers coverage for are annual physical examinations, flu shots, routine mammograms and cancer screenings.

Change in Coverage

In case an enrolee gets other health coverage including Medicare, Medicaid, or Private insurance, he loses eligibility for PCIP.

In case an enrolee moves to another state he can get information about any change to his coverage from National Finance Centre. If an enrolee moves out of the service area of the federally-run PCIP, he doesn’t need to be uninsured for another 6 months to be eligible to enrol in another PCIP in new area.

To change the address the enrolee needs to submit a written request for a mailing address change to National Finance Centre.

To get new ID card the enrolee needs to call the PCIP benefits administrator.

Paying for PCIP

There are no discounts or waivers for PCIP monthly premiums. First premium payment is due within 30 calendar days from the date of approval letter. With the first payment coverage starts. Then enrolee gets monthly coupons to send with future payments. Payments are due on or before the first day of each month. Late payments could lead to cancellation of PCIP. One can make premium payments by checks payable to the National Finance Centre or electronic transfer of funds. No payments by credit card or phone are accepted.

Cancellation of PCIP Coverage

The PCIP coverage is cancelled if the premium is not paid on time. The insurance coverage ends on the last day of the month for which full monthly premium payment has been done. If an enrolee couldn’t pay premium on time because of certain circumstances he may appeal the decision of cancellation of coverage. Special circumstances include a natural or manmade disaster or a hospitalization. To appeal the decision he we must submit a signed and dated letter to PCIP appeals within 30 days of the date on the disenrollment notice. Appeal must have detail of circumstances preventing the payment of premium on time. The appeal must also include the account number of the enrolee.

How to Disenroll from PCIP

To disenroll from PCIP an applicant must submit a signed and dated written request to National Finance Centre that includes his name, permanent address, account number and the date he intends to get disenrolled from. The disenrollment is effective starting the last day of the month in which the request is received. Premium for that month must be paid in full. People, who have disenrolled from the program, cannot re-apply as PCIP has suspended acceptance of new enrolment until further notice.

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