Updates on the Temporary High-Risk Pool Program
Health and Human Services (HHS) recently announced several changes to the Pre-Existing Condition Insurance Plan (PCIP) temporary high-risk pool program. The high-risk pool program was formed as part of health care reform legislation to help provide affordable health insurance coverage to people who are uninsured due to pre-existing conditions.
States can choose to participate in the program which is funded entirely by the Federal government and will end on January 1, 2014, when health insurance exchanges are formed.
Update on Eligibility Requirements
Starting July 1, 2011, in the 23 states and District of Columbia where HHS administers the federal PCIP, applicants will no longer need an insurance denial letter to be eligible. Instead, individuals can provide a letter from a doctor, physician assistant or nurse practitioner dated within the past 12 months stating that “they have or, at any time in the past, had a medical condition, disability or illness.” This same change was made for children in February. Other eligibility requirements would still apply, including having to have been uninsured for at least the last six months.
HHS does not administer the federal PCIP high-risk pools in Kansas or Missouri because both states have agreed to administer the federal pool in addition to their own respective state high-risk pools. Under a new bill passed in May, for the Kansas high-risk pool, Kansas no longer requires a child younger than 19 years of age to provide a denial letter from an insurance carrier in order to be eligible in those Kansas counties where child-only coverage is not available. For children living in a Kansas county where child-only coverage is available (i.e. Johnson and Wyandotte Counties), to be eligible for the Kansas high-risk pool, a letter from a carrier demonstrating that the premium rate quoted was in excess of the high-risk pool rate is still required.
Note to Agents and Brokers: HHS stated that, starting this Fall, it will “begin paying agents and brokers for successfully connecting eligible people with the PCIP program.” No further information about these payments was provided.