PCIP suspending new enrollment applications
Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications
until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide. We encourage you to
visit http://finder.healthcare.gov to explore your other health care options.
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, 8 a.m. to 11 p.m. EST, if you believe you are eligible.
The Health Insurance Marketplace
Starting next year, 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 will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov to learn more about the Marketplace.
Plan changes for 2013
Beginning with January 14, 2013, dates of service, new PCIP enrollee coinsurance and out-of-pocket costs will be effective. 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. Starting 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. The coinsurance will count toward your prescription drug deductible and out-of-pocket limit, regardless if you get them filled at a retail pharmacy or through Express Scripts/Medco, our mail-order pharmacy. Please see our 2013 PCIP Brochure [PDF download] or call us at (800) 220-7898 if you have questions.
More information about 2013 benefit changes
PCIP offers one plan to people enrolled in the program. The Standard Plan has a $2,000 annual medical deductible and a $500 annual drug deductible. For more information, including changes to formulary maintenance drugs in 2013, click benefits.
Health assessment: Complete yours within 90 days
Your assessment will help us learn about your health needs and how we can best help you. The simple online questionnaire identifies your health risks and needs as you transition to PCIP coverage. To get started, just click Health Assessment.
Is my state in PCIP?
PCIP varies depending on your current state of residence. GEHA is administering PCIP benefits in more than 20 states for HHS, while other states will run their own Pre-Existing Condition Insurance Plan. To find out about your state, click PCIP Map.
