Pre-Existing Health Insurance Plans: Good News For Hard to Insure Individuals
One of the biggest challenges many people have is to obtain individual health insurance when they have a pre-existing health conditions. Many times the pre-existing conditions may not seem very severe to an individual such as diabetes or health condition that occurred many years ago, but still, many insurance companies may refuse to underwrite a policy making it very difficult for an individual to obtain individual health insurance.
Now there is an option for people who have had a difficult time obtaining individual coverage.
The Affordable Care Act which is part of healthcare reform has introduced new “Pre-Existing Insurance Plans” and each state is allocated up to $5 billion by the federal government. This is a transitional plan until 2014 when insurance companies will be required to accept everyone regardless of health conditions. It is important to realize that these plans are not free but they do serve as an excellent option for some people who in the past had little to no options. Georgia currently has this pre-existing insurance plan and there are 3 basic criteria for acceptance.
There are 3 basic requirements in order to enroll in the program, individuals must:
1. Be a citizen or national of the United States or lawfully present in the United States.
2. Have been uninsured for at least the last six months.
3. Have had a problem getting insurance due to a pre-existing condition.
Who is NOT eligible?
- Individual covered by Medicare or Tricare
- Individual with job based coverage
- Individual with COBRA coverage
- Or individual coverage
How does someone prove they have a pre-existing condition?
Basically you need to submit a denial letter from an insurance company stating that you have been turned down due to a pre-existing health conditions. Some states also have stated illnesses criteria and if you have any of those illnesses, you may be eligible.
How are the benefits structured?
There are 3 basic plan options that are very similar to major medical benefits offered by insurance companies with co-pays for office visits, prescription benefits and a deductible and co-insurance for hospitalization and other major services. You can get more details on the plans at www.pcip.gov. Another great website you can find answers is www.healthcare.gov
Benefit Options
Currently there are 3 options. Each plan has a max out of pocket of $5950/yr. There is a network of preferred providers you can view on healthcare.gov. You can also obtain a rate sheet for your state on their website.
Standard option:
- $2000 deductible plan in network.
- $25 co-pay for office visits.
- $500 Rx deductible with generous benefits for Rx.
Extended option:
- $1000 deductible
- $25 co-pay for office visits
- $250 Rx deductible instead of $500 with lesser co-pays for
HSA Option:
- $2500 deductible
For a complete list of benefits, please visit pcip.gov or healthcare.gov.
How Do you Apply?
Go to www.pcip.gov and download the application for enrollment and submit it to them along with your proof of pre-existing condition or letter of declination from an insurance company.
The Pre-existing insurance plans are may also be a good option for individuals who are over age 65 who are not eligible for Medicare. Many of our community have parents that have come into the country and are legal citizens and residents but have not worked enough quarter hours to be eligible for Medicare. Since most insurance companies will not accept people over age 65 who are not Medicare eligible, this may be a good option for those folks.
If you would like to listen to an audio podcast on pre-existing insurance plans, you can go to our website on GeorgiaHealthbenefits.com or go to iTunes and look for Moneywise Podcast hosted by Rajesh Jyotishi. We are NOT brokers for the pre-existing health plans, but if you have any questions, we are happy to help. You are welcome to contact me at 770-451-1932 x 101 or RJ@Shalinfinancial.com
[Rajesh Jyotishi is an insurance agent and financial advisor in the Atlanta area. He has been in the insurance and financial services industry since 1991 and hosts the Moneywise column in Khabar magazine. His specialty is in life & health insurance for individuals and business owners. For questions, he can be reached at 770-451-1932 x 101. RJ@Shalinfinancial.com For an audio podcast on pre-existing insurance coverage, go to georgiahalthbenefits.com.]
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