Group Touts Federal ‘Pre-Existing Condition’ Provision Set to Take Effect July 1

Press Release from the Tennessee Health Care Campaign; June 2, 2011:

Tennesseans with pre-existing medical conditions will have new, more affordable options on July 1

Nashville, TN – Effective July 1, comprehensive health insurance will be more affordable for thousands of Tennesseans with a pre-existing medical condition. “The Tennessee Health Care Campaign is thrilled by these changes in the Federal High Risk Pool, called Pre-Existing Condition Insurance Plan (PCIP),” says Beth Uselton, Executive Director of THCC. “Now, an 18 year old can get comprehensive insurance for as little as $133/month. This is an important development for the implementation of the new health care law, the Affordable Care Act, an it shows that the Department of Health and Human Services is responsive to the shifting needs of different states,” says Uselton.

Application to the PCIP still requires multiple steps, but in most cases, the process will be much easier. First of all, the person can apply on line by going to https://www.pcip.gov/ Once they complete their application on line, they will have 10 days to send in additional information documenting their citizenship and their medical condition. Secondly, the individual will no longer need a denial letter from an insurance company; they can simply get a letter from their doctor verifying their medical condition. It will take about three weeks to completer the application process. By starting now, an individual may be able to get health insurance beginning July 1.

Monthly premiums for the PCIP have also been reduced in 18 states where the federal government administers the program. In Tennessee, premiums will drop by 18.4%. For monthly premiums for different age groups in Tennessee, click here: https://webaccounts.geha.com/public/pcip/rates/rates.asp?id=19

“The major hurtle for most individuals with medical conditions will be the time that a person has to be uninsured, or ‘gobare’, before they can qualify for the program. They have to be uninsured for 6 months,” says Uselton. This is not ideal by any means, but overall the application process will now be much easier and much more affordable.”

The state of Tennessee is still operating its high risk pool called Access Tennessee. One good news about Access Tennessee is that a person does not have to wait 6 months. If an individual has insurance and loses it and does not have a gap of more than 28 days, they can have continuous coverage with no gap. The draw back with Access Tennessee is that it is much more expensive. You can go to Access Tennessee and see what it offers by going to http://www.covertn.gov/web/access_tn.html Access Tennessee has also developed a comparison between PCIP and Access Tennessee. For a copy, click http://www.covertn.gov/web/pcip_chart.pdf

The Pre-Existing Condition Insurance Plan is created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but un-enrolled. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604). The toll-free number for Access Tennessee is 1-866-636-0080.