Updated Timely Filing and Appeals Timeframes
All 2014 claims for the Pre-Existing Condition Insurance Plan (PCIP) must be received no later than 3 months from the date of
service. The timeframe for an enrollee to appeal PCIP's benefit determination is 2 months from the date of our decision.
The federally-run Pre-Existing Condition Insurance Plan (PCIP) has suspended acceptance of new enrollment applications
until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.
Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of
residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday-Friday, 9 a.m. to 5 p.m. EST, if you believe you are eligible.
Transition Plan effective July 1, 2013
The Transition Plan is limited to enrollees transferring from a state-run PCIP in Arkansas, California, Colorado, Iowa, Illinois, Kansas, Michigan, Missouri, New Hampshire,
New York, North Carolina, Ohio, Oregon, Pennsylvania, South Dakota, Utah and Washington.
Effective July 1, 2013, the coinsurance will be 30%, and the out-of-pocket maximum will be $3,125, or $5,000 for non-formulary prescriptions, for the Transition Plan.
To learn more about these changes, click Plan Materials and download the 2013 PCIP Brochure.
Prescription drug refill change
At the beginning of the 2013 plan year, PCIP only covered formulary and generic prescription drugs from a retail
pharmacy the first two times you had them filled. The third fill and after had to be filled through mail order. That
is no longer required. Effective February 15, 2013, you can get your formulary and generic prescription drugs at a
retail pharmacy even after the first two fills. On the third fill and after for both formulary and generic prescriptions,
you will pay the standard coinsurance or 50%, whichever is greater. To avoid the possibility of a greater coinsurance,
check out the mail-order options available at (800) 427-6145. Please see our 2013 PCIP Brochure [PDF download]
or call us at (800) 220-7898 if you have questions.
The Health Insurance Marketplace
The Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will
finally have access to quality, affordable coverage. People can now apply for health insurance coverage through the Health
Insurance Marketplace. Open enrollment is from October 1, 2013 through March 31, 2014. Coverage begins on January 1, 2014.
Visit www.healthcare.gov to learn more about the Marketplace.