Standard Plan
PCIP provides preventive care (paid at 100%, with no deductible) when 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 medical deductible and a $500 prescription deductible before PCIP pays for a percentage of the covered services for the Standard Plan. After you have met the deductible, you will pay 30% of medical costs for covered services.

For 2013, the maximum you will pay out-of-pocket for covered services in a calendar year is $6,250, or $10,000 for non-formulary prescriptions, for the Standard Plan.

There is no lifetime maximum or cap on the amount the plan pays for your care.

Click here for the 2013 Standard Plan Benefits Summary (PDF).

Transition Plan
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.

PCIP provides preventive care (paid at 100%, with no deductible) when the doctor indicates a preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a $1,000 medical deductible and a $250 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 services.

For 2013, the maximum you will pay out-of-pocket for covered services in a calendar year is $3,125, or $5,000 for non-formulary prescriptions, for the Transition Plan.

Click here for the 2013 Transition Plan Benefits Summary (PDF) limited to Arkansas, California, Colorado, Iowa, Illinois, Kansas, Michigan, Missouri, New Hampshire, New York, North Carolina, Ohio, Oregon, Pennsylvania, South Dakota, Utah and Washington.

The availability and unavailability of membership in the Pre-Existing Condition Insurance Plan (PCIP) and any benefits authorized 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 are dependent on continued availability of federal funding.