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PCIP Coverage for April 2014

Enrollees in the federally-run Pre-Existing Condition Insurance Plan (PCIP), who have not yet found new health insurance coverage through the Marketplace, can purchase an additional month of PCIP coverage through April 30, 2014, while they continue their search. Time is running out. You need to act to avoid a lapse in coverage. Open enrollment through the Marketplace for this plan year ends on March 31. Enrollees will be notified by mail of this option to extend their PCIP plan through April, along with details about cost-sharing. Eligible enrollees can purchase PCIP transitional coverage by sending in an April premium payment; which will be the same monthly rate that they paid for January-March 2014. Click here for the 2014 Benefits Summary.

Click to download plan materialsClick here for information on prescriptionsClick here for provider informationClick here for frequently asked questions

PCIP Suspension

The federally-run Pre-Existing Condition Insurance Plan (PCIP) has suspended acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.

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, 9 a.m. to 5 p.m. EST, if you believe you are eligible.

Transition Plan effective July 1, 2013

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.

Effective July 1, 2013, the coinsurance will be 30%, and the out-of-pocket maximum will be $3,125, or $5,000 for non-formulary prescriptions, for the Transition Plan. 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. Effective 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. Please see our 2013 PCIP Brochure [PDF download] or call us at (800) 220-7898 if you have questions.

The Health Insurance Marketplace

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 can now apply for health insurance coverage through the Health Insurance Marketplace. Open enrollment is from October 1, 2013 through March 31, 2014. Coverage begins on January 1, 2014. Visit to learn more about the Marketplace.

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