Pre-Existing Condition Insurance Plans Rules Changing

Could the rules governing pre-existing medical conditions in your state be changing?

As part of the Patient Protection and Affordable Care Act (commonly referred to as health care reform), Congress created new insurance options for individuals who have a pre-existing condition and as a result are unable to buy individual health insurance policies. While the exact name for these plans differs by state, generally they are referred to as Pre-Existing Condition Insurance Plans (PCIP). Some of these insurance plans are operated by the state and in 23 states these plans are operated by the federal government through the U.S. Department of Health and Human Services (HHS).

On May 31, 2011, HHS announced that they would be reducing premiums in many states to make it easier for people to enroll in these plans. In 17 states and the District of Columbia, premiums will be reduced up to 40%, bringing costs for the PCIP programs closer to the rates of the states’ individual health insurance markets.

In addition to reducing premiums, eligibility requirements for the federally run PCIP programs will also be relaxed. To qualify for a PCIP, individuals must be U.S. Citizens or lawfully present in the U.S., have a pre-existing condition, and have been without health insurance for the past six months. Previously, individuals had to apply for an individual health insurance policy, wait for a denial letter, and then apply for the PCIP program in their state. Often times this would result in an even longer delay in obtaining health insurance. Recognizing the flaw with this requirement, HHS will now accept a letter from doctor, physician assistant, or nurse practitioner stating that the applicant has a pre-existing condition or illness.

These changes will make obtaining health insurance more affordable for and accessible to those coping with cancer. It is important to note that these changes only apply to states in which HHS is running the PCIP program. However, HHS has sent a letter to the other 27 states letting them know about the opportunity to amend their programs as well. For more information about the PCIP plan in your state, please visit or contact the CLRC at 866-THE-CLRC.


Leave a Reply