Frequently asked questions

What is the Pre-Existing Condition Insurance Plan?
The Pre-Existing Condition Insurance Plan (PCIP) was created as part of the nation's new health insurance law, the Affordable Care Act. The PCIP program was designed to make health insurance available to you if you have been denied coverage by private insurance companies because of a pre-existing condition. PCIP provides a health coverage option for you if you have been uninsured for at least six months, you have a pre-existing condition or have been denied health coverage because of your health condition, and are a U.S. citizen or are residing here legally. PCIP is a transitional program until 2014.

What is going to happen to my PCIP coverage when the program ends in 2014?
In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an exchange. An exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. If you are enrolled in PCIP, we will provide additional information about how your Pre-Existing Condition Insurance Plan coverage will change and how you can take advantage of the new coverage options available in 2014.

How do the legislation/lawsuits attempting to repeal the Affordable Care Act affect my PCIP coverage?
The Affordable Care Act remains the law of the land. We recognize how important the Pre-Existing Condition Insurance Plan is to you and will let you know if there are any changes that could affect your coverage.

Who is eligible for coverage through PCIP?
Eligible individuals must:

• Be a U.S. citizen or a legal resident
• Have a pre-existing medical condition
• Not have been covered under creditable health coverage (as defined by Section 201(c)(1) of the Public Health Service Act) for the previous six months before applying for coverage

Persons currently covered by a health plan, including employer plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for PCIP.

How do I enroll?
If PCIP in your state is run by the federal government (administered by GEHA), it's simple. Download an application online at www.pcip.gov, or call the customer service department toll-free at (866) 717-5826 (TTY 1-866-561-1604) and ask for an application.

How do I know if PCIP in my state is run by the federal government?
You can click to see a map of the PCIP states administered by GEHA.

How is the PCIP funded?
The program is funded entirely by the federal government. The health reform law allocated $5 billion for the program nationwide. Funding will go toward health care claims and administrative costs that exceed the premiums collected for PCIP.

What benefits are included for enrollees?
The same benefits will be provided in all states administered by GEHA. In these states, enrollees can choose from three health plans with both a deductible and an annual maximum amount of out-of-pocket expense. That means that they will be responsible for health care costs up to a specified dollar amount, then PCIP will begin paying benefits. After the out-of-pocket maximum has been met, the plan pays the expenses in full.

Coverage includes doctor visits, hospitalizations and prescription drugs. Enrollees will get better benefits when they use in-network providers. There are no waiting periods. Pre-existing conditions are covered.

For more details, click on PCIP benefits.

What will enrollees pay for premiums?
Premiums will vary depending on the state you live in and which health plan you choose. To see rate information for the PCIP states administered by GEHA, click on premium rates.

For information on other state plans, click on www.pcip.gov.

What doctors and hospitals are included in the plan?
Enrollees will have access to the PCIP network of providers. Click to search online for providers.

What happens to enrollees in existing high-risk pools?
Currently, 34 states operate high-risk pools. The new national program will not affect individuals already covered by a state high-risk pool. Those individuals will maintain their current coverage.

Can my family be covered under my plan?
Coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.

Does PCIP have a broker referral payment program?
Yes. PCIP pays a $100 referral fee for any qualified referrals to and confirmed by PCIP in the federally administered PCIP states. For more information and to register, click broker referral payment program.

What is GEHA?
Government Employees Health Association (GEHA) currently contracts with the federal government to provide health plans and dental plans to civilian federal employees and retirees. Founded as a health plan for railway mail clerks more than 70 years ago, GEHA now provides benefits to more than 1 million covered lives worldwide. The company has experience with multiple government contracts and significant expertise in provider networks, pharmacy benefits, managed care and health information technology. GEHA is based in the Kansas City, Mo., area and operates as a not-for-profit association.