SC Pre-Existing Condition Insurance Plan
The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition. This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.
What is the Pre-Existing Condition Insurance Plan?
The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people if they have had a problem getting health insurance due to a pre-existing condition.
How do I know if I am eligible for coverage through PCIP?*
Eligible individuals must:
- Be a U.S. citizen or a legal resident
- Have a pre-existing medical condition
- Not have been covered under health coverage for the previous six months before applying for coverage (proof of denial from insurance company will be needed)
How do I enroll?
You can enroll for the Pre-Existing Condition Insurance Plan online at www.pcip.gov, or call the PCIP customer service department toll-free at (866) 717-5826 (TTY 1-866-561-1604) and ask for an application.
When will my PCIP coverage be effective?
A completed PCIP 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. For example: If the applicant enrolled between 8/1/2010-8/15/2010, they are effective 9/1/2010, and if they enroll between 8/16/2010 and 8/31/2010, they are effective 10/1/2010.
How much does the Pre-Existing Coverage Insurance Plan cost me?**
Monthly Premium: South Carolina
0 to 18
19 to 34
35 to 44
45 to 54
What benefits do I receive under PCIP?
- $1,000 to $3,000 annual deductible (except for preventive services, which have no copay or deductible), varies by plan option
- Patient pays 20 percent of the cost of covered benefits
- Out-of-pocket costs capped at $5,950 per year
- No lifetime maximum
Preventive services include: periodic health evaluations (e.g. annual physicals), screening services (e.g. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.
*Persons currently covered by a health plan, including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for the Pre-Existing Coverage Insurance Plan. PCIP coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.
**The following link provides complete detail on all covered services, including all preventive services and member out of pocket responsibilities http://www.pciplan.com/forms/pdfs/brochure.pdf; premiums may be subject to changes made by PCIP.