PCIP provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a $2,000 in-network medical deductible and a $500 prescription deductible before PCIP pays for a percentage of the covered services. After you have met the deductible, you will pay 30% of medical costs for in-network services.
For 2013, the maximum you will pay out-of-pocket for covered services in a calendar year when you use an in-network provider is $6,250.
There is no lifetime maximum or cap on the amount the plan pays for your care.
Click here for the 2013 Benefits Summary (PDF).
The availability and unavailability of membership in the Pre-Existing Condition Insurance Plan (PCIP) and any benefits through the plan are at all times subject to federal law, regulations, and the contract between the PCIP Administrator and the United States Department of Health and Human Services, and is dependent on continued availability of federal funding. Any authorizations for treatment or service given by the PCIP Administrator simply confirms that the treatment or service is a covered benefit under the Plan and will be reimbursed, if funds are available, in an amount determined under the terms of the Plan. Actual reimbursement by the Plan for such treatment or service can only be made from the PCIP fund established by Congress and no payment can be made to any member or provider, even if prior authorization for the treatment or service was given, if federally-appropriated PCIP funds are exhausted.