A new high-risk pool insurance program — the first major health coverage expansion under the Patient Protection and Affordable Care Act of 2010 — will be available starting this summer.

The temporary insurance program, entitled the Pre-Existing Condition Insurance Plan (PCIP), is intended to help people who have been unable to obtain health insurance due to pre-existing medical conditions such as diabetes, hypertension, cancer, or injury.

The program will run until January 1, 2014, when the Affordable Care Act is fully enacted.

A provision in the Affordable Care Act provides $5 billion in federal funding to support state PCIPs for the next four years. States can use the funding to subsidize the costs of running their own PCIP and to reduce premiums for participants.

States also have the option of opting out, in which case the federal government will provide a PCIP for the state’s residents. Twenty states have opted out of running their own high-risk pools.

Details of PCIP, including which states are operating their own PCIP or have opted out, are available in Health Reform Facts 2 (pdf), the second fact sheet in PHI Health Care for Health Care Workers‘ series on how health reform affects direct-care workers and their employers.

Eligibility

In order to be eligible for coverage through PCIP, an individual must meet the following requirements:

• Be a U.S. citizen or legal resident;
• Not have had coverage through a private group or individual health insurance plan, an existing state high-risk pool, COBRA, or a public program like Medicaid for six months prior to applying for coverage; and
• Have a pre-existing condition.

How to Apply

For more information, including full eligibility requirements and application instructions, visit www.pcip.gov.

“I strongly encourage workers to explore their eligibility for this program,” said Carol Regan, national director of the PHI Health Care for Health Care Workers campaign. “This may be an opportunity for some uninsured workers with pre-existing conditions to finally get coverage.”

To receive the Health Reform Fact Sheets as they are released, subscribe to PHI’s Health Care for Health Care Workers email alerts.

– by Deane Beebe