PCIP has been available since July 2010 and is financed differently across states, either by the Federal Government or by the Dept. of Health and Human Services. PCIPs don’t substitute state high risk pools. However, premiums are lower. If you’re looking for a Pre-existing Condition Insurance Plan, you can find and compare plans New York offers. Federally financed pre-existing condition insurance provide 1) standard plans, 2) extended plans with lower deductible and higher premiums, and 3) a plan that mixes a high deductible with a health savings account. You can also find detailed information about your state’s PCIP by calling the Dept. of Health and Human Services at 866-717-5926.
Limitations:
In order to receive the benefits of the PCIP, you must be uninsured for a minimum of 6 months. People who are already matriculated in state high risk groups or those who have private insurance are not eligible even though the new plan is significantly less expensive. Federal government administered plans and policies run by the state have different restrictions and application processes.
Federally managed plans require evidence that you have applied for individual insurance and were refused coverage because of your pre existing health condition. You can also present proof of authorized coverage but with a carrier that ignored payment for your condition (It’s important to note that if you buy this type of policy, you will no longer be a candidate for a PCIP).
If you are uninsured, you may have to apply for insurance just to provide evidence that you were denied coverage.
State administered insurance plans have less strict requirements. Few will ask for evidence of denial. Some will automatically approve people with specific pre existing health conditions approved by a physician. Specific pre existing conditions include asthma or diabetes.
Appropriate Plans:
The Federal government allotted $5B to finance the new PCIP’s. Individual premium with subsidies will cost a 50 year old about $320- $570.
State administered PCIP’s base premiums on what the private insurance companies charge. Connecticut premiums cost up to $890 per month.
Carefully compare your options. All three Federally run plans provide full coverage for preventive care; screenings and physical exams. Each option requires a 20% co-pay for other medical visits (40% for out of network care) and an annual fee of $5,950 ($7,000 out of network providers).
Deductible cost is the most important factor. The standard health plan has a $2,000 deductible ($3,000 out of network care) is less than the extended plan’s $1,000 and $1,500 deductibles.
If you have a business in New York or New Jersey and are financially burdened with New York or New Jersey employee medical insurance, New York or New Jersey General Business Insurance and would like to find ways to reduce your expenses, Metropolitan Risk Advisory can provide you with the advice and tools your business is looking for.