About the Law

• What is a pre-existing condition?
• Will the Pre-Existing Condition Insurance Plan (PCIP) be available in every state?
• When will my coverage be effective?
• May I apply for PCIP if I have COBRA or other continuation coverage?
• May I apply for the Pre-Existing Condition Insurance Plan if I have existing health coverage?
• What health care providers are in the network?
• What do I do if I can’t afford these premiums?

 What is a pre-existing condition?

A pre-existing condition is a  condition, disability or illness (either physical or mental) that you have before you enrolled in a health plan.

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 Will the Pre-Existing Condition Insurance Plan (PCIP) be available in every state?

Yes—whether the state or the U.S. Department of Health and Human Services runs the program depends on the state.  The program name, start, and design may vary depending on which state you live in. 

Read about the PCIP, eligibility, how to apply, and benefits; then use the PCIP Map to learn more about how PCIP works in your state.

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 When will my coverage be effective?

If you live in a state where the U.S. Department of Health and Human Services is running the program, you can apply and enroll starting July 1, 2010.  Coverage will begin August 1 if you apply and are approved for enrollment by July 15^th.  Generally, a completed application received on or before the 15th of the month will go into effect on the first day of the next month. A completed application received after the 15th of the month will go into effect on the first day of the following month.

Read about the PCIP, eligibility, how to apply, and benefits; then use the PCIP Map to learn more about how PCIP works in your state.

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 May I apply for the Pre-Existing Condition Insurance Plan if I have existing health coverage?

You are not eligible unless you have been without health coverage for at least the last six months.  For example, if you have Medicare or TRICARE, you shouldn’t apply.  If you are uninsured and have been told that you may be eligible for other coverage programs like Medicaid and the Children’s Health Insurance Program, you should check out those programs first, as they may better meet your needs.  If you have job-based coverage, or individual insurance coverage, you aren’t eligible to apply.

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 May I apply for PCIP if I have COBRA or other continuation coverage?

No, even if your COBRA or other continuation of coverage is about to run out, you won’t meet the requirement to be uninsured for at least the last six months.  You also need to be meet the criteria for having a pre-existing condition and be a U.S. citizen or individual residing here legally to qualify for the Pre-Existing Condition Insurance Plan.

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 What health care providers are in the network?

The Pre-Existing Condition Insurance Plan will have provider networks that include a full range of services and specialists.

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 What do I do if I can’t afford these premiums?

If you have limited income and resources (assets), you may be eligible for the Medicaid program in your state.  If you are seeking insurance coverage for your child, go to www.insurekidsnow.gov to learn more about children’s health insurance in your state.

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