Eligibility
To download an Application Form, go to www.pcip.gov. Your eligibility for the Pre-Existing Condition Insurance Plan will be determined by the National Finance Center after your application is received.
To be eligible for the Pre-Existing Condition Insurance Plan:
- You must be a citizen or national of the United States or lawfully present in the United States.
- You must have been uninsured for at least the last six months.
- You must have a pre-existing condition. To prove this, you will be asked as part of the application process to submit one of the following documents dated within the past 12 months:
- A letter from a doctor, physician assistant or nurse practitioner stating that you have or had a medical condition, disability or illness. This letter must include your name and medical condition, disability or illness, and the name, license number, state of licensure and signature of the doctor, physician assistant or nurse practitioner.
- A denial letter from an insurance company licensed in your state for individual insurance coverage. Or you may provide a letter from an insurance agent or broker licensed in your state that shows you aren’t eligible for individual insurance coverage from one or more insurance companies because of your medical condition.
- An offer of individual insurance coverage that you did not accept from an insurance company licensed in your state for individual insurance coverage. This offer of coverage has a rider that says your medical condition won’t be covered if you accept the offer.
For children under age 19 or persons who live in Massachusetts or Vermont: You must have been quoted a premium of 200% or more of the Pre-Existing Condition Insurance Plan premium for the Standard Option in your state.
To be approved, you must submit a complete application with all required documentation, including proof of citizenship. For more details on eligibility or to download an Application Form, go to www.pcip.gov.
States where PCIP is administered by GEHA
In the green states on the map, PCIP is provided by HHS and administered by GEHA. For these states, go to PCIP premium rates and PCIP benefits. For any other state, go to www.pcip.gov.
