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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

 

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.