Pre-Existing Condition Insurance Plan

In March of 2010, Congress passed and President Obama signed the Affordable Care Act — the new health insurance law. The law creates a new program — the Pre-Existing Condition Insurance Plan — to make health insurance available to you if you have been denied coverage by private insurance companies due to of a pre-existing condition.

If you’ve been locked out of the insurance market, the Pre-Existing Condition Insurance Plan program may be able to help you through 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange and you will no longer be discriminated against based on a pre-existing condition.

The Program:

• Covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.
• Doesn’t charge you a higher premium just because of your medical condition.
• Doesn’t base eligibility on income.

ELIGIBILITY

There are a few requirements to meet before you can enroll in the Pre-Existing Condition Insurance Plan – regardless of whether your program is run by the U.S. Department of Health and Human Services or your state. Applicants must:

• Be a citizen or national of the United States or reside in the U.S. legally.
• Have been without health coverage for at least the last six months. Please note that if you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-
• Existing Condition Insurance Plan.
• Have a pre-existing condition or have been denied coverage because of your health condition.

If the Pre-Existing Condition Insurance Plan in your state is run by the U.S. Department of Health and Human Services, you can call 1-866-717-5826 (TTY 1-866-561-1604) and ask for an application or go to www.pcip.gov and go to “apply”.

How to Apply in Hawai‘i for the Pre-Existing Condition Insurance Plan

To apply, you will need to provide a copy of one of the following documents, which will be used to make a decision on your application:

• A denial letter from an insurance company licensed in your state for individual insurance coverage (not health insurance offered through a job) that is dated within the past 12 months. Or, you may provide a letter dated in the past 12 months 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 (not health insurance offered through a job) that you did not accept from an insurance company licensed in your state that is dated within the past 12 months. This offer of coverage has a rider that says your medical condition won’t be covered if you accept the offer.
• A letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating your name and current or past medical condition, disability, or illness. This letter must also include the name, license number, state of licensure, and original signature of the doctor, physician assistant, or nurse practitioner.

For more information or the rates in Hawai‘i, please call the Hawaii State Health Insurance Assistance Program (SHIP)/ Sage PLUS Program at 586-7299 or 1-888-875-9229. We are a volunteer based Medicare counseling program for the State of Hawai‘i.