Pre-Existing Condition Insurance Plan Officially Opens in California
Details of New High-Risk Pool
The Pre-existing Condition Insurance Plan is the first consumer program to be offered under the federal health reform law.
The high-risk pools are designed to bridge the coverage gap until 2014, when the reform law will prohibit insurers from denying health coverage or charging higher rates to individuals with pre-existing conditions.
To qualify for PCIP, individuals must:
- Be U.S. citizens or legal residents;
- Have been uninsured for at least the previous six months; and
- Have been denied insurance coverage because of a pre-existing medical condition (Colliver, San Francisco Chronicle, 10/26).
The federal government is providingÂ about $761 million to help California operate its high-risk pool until 2014. The pool is expected toÂ provide coverage for aboutÂ 23,000 Californians during any given monthÂ (Central Valley Business Times, 10/25).
Jeanie Esajian -- deputy director of the Managed Risk Medical Insurance Board -- said the state has received more than 830 applications for the federally funded pool and sent out more than 6,420 applications to prospective participants as of last week.
Existing State Pool
The launch of California's PCIP was delayed for several weeks because many insurers that participate in the state's existing high-risk pool declined to take part in the new federally funded program. As a result, the state negotiated with third-party contractors to administer its PCIP.
The federally funded health insurance pool is operating alongside the state's existing pool, and MRMIB is administering both programs.
Coverage Details, Rates
PCIP does not include a lifetime limit on benefits. The existing state-run high-risk pool limits lifetime benefits to $750,000 and annual benefits to $75,000 (San Francisco Chronicle, 10/26).
The federally funded pool also offers coverage at lower rates than the state-run pool (Robertson, Sacramento Business Journal, 10/25). Â Premiums for PCIP are based on the beneficiary's age and geographical location, not medical conditions or risk factors such as smoking.
For example, PCIP rates in the San Francisco Bay Area range from $140 monthly for people ages 15 and younger to $1,003 monthly for people older than age 74 (San Francisco Chronicle, 10/26).
For additional coverage of California's federally funded high-risk pool, see today's Capitol Desk post.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.