Diabetics in the PCIP receive immediate benefits with no waiting period.
The 2010 health reform law ends common practices among health insurers that deny or limit insurance coverage to those with pre-existing conditions. Though these protections will not become effective until 2014, the law creates temporary state and federal health insurance pools that offer benefits to uninsured individuals with high-risk medical conditions. Georgia opted to participate in the federal pre-existing condition insurance pool, or PCIP, rather than create its own insurance pool for qualifying residents.
Qualifications
To qualify for insurance through the federal pre-existing condition insurance pool, applicants must be residing in Georgia or elsewhere in the U.S. legally and have an existing medical condition for which they were denied health insurance. Unfortunately, those with existing health insurance that excludes coverage for a pre-existing condition will not qualify. Additionally, applicants must have been uninsured for a minimum of six months prior to enrolling in the federal PCIP.
Coverage
According to PCIP.gov, anyone who enrolls in an insurance plan available through the federal pre-existing condition health insurance pool will have access to a full range of benefits, including care from a primary physician, hospital care, emergency care and prescription drug coverage beginning on the first day the health insurance policy becomes effective. This means there are no waiting periods before insurers will pay benefits---including for services used to treat an existing medical condition. Additionally, all of the insurance plans available in the federal high-risk insurance pool include free preventive medical care for services such as flu shots, yearly check-ups and recommended cancer screenings.
Plan Options
The PCIP features three insurance plans, all of which pay 80 percent of health service costs after a deductible is met, though annual out-of-pocket expenses cannot exceed $5,950 for in-network services. One of the insurance plans is an HSA-qualifying policy, which allows policyholders to set up tax-exempt health savings accounts out of which they can pay for IRS-qualifying medical expenses with non-taxable income. Health insurance premiums for the three insurance plans are as low as $174 and as high as $749 per month, but the PCIP determines premiums based on age, rather than health.
Future Changes
The Affordable Care Act protects those with pre-existing conditions beginning in January 2014, requiring that all insurers accept and cover those with medical conditions the same as they would a healthy person of the same age. At that time, the federal government and other states will close high-risk health insurance pools, and those previously enrolled in high-risk insurance plans will have access to the same insurance options and premium rates that those without pre-existing conditions will have.
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