Monday, June 6, 2011


Eligible residents of Virginia can apply for health insurance coverage through the Pre-Existing Condition Insurance Plan (PCIP) program run by the U.S. Department of Health and Human Services.
Congress created the temporary PCIP program as part of the Affordable Care Act to help uninsured Americans with a variety of medical conditions get affordable coverage rather than be locked out of the system by insurance companies. In 2014 and beyond, insurers will be prohibited from denying coverage to anyone with a pre-existing condition and new competitive marketplaces called Health Insurance Exchanges will give people the opportunity to shop for the policy that best suits their needs. Millions of Americans also will receive tax credits to help make coverage affordable.
PCIP provides Americans living with such conditions as cancer, diabetes, or heart disease the opportunity to obtain insurance coverage. The program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market.
To qualify for PCIP coverage:

• You must be a citizen or national of the U.S. or lawfully present in the U.S.

• You must have been uninsured for at least the last six months before you apply.

• You must have a pre-existing condition or have been denied coverage because of your health condition. Starting July 1, 2011, you can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that you have or, at any time in the past, had a medical condition, disability, or illness. A denial from an insurance company is not needed!
PCIP covers a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a preexisting condition.

New Virginia Premium Rates (July 1, 2011) are lower and much more affordable

Age Standard Option Extended Option HSA Option
0 to 18 $93 $125 $97

19 to 34 $140 $188 $145

35 to 44 $168 $226 $174

45 to 54 $214 $288 $222

55+ $297 $401 $309

In addition to your monthly premium, you will pay other costs. Before most medical benefits are covered, you must first pay a deductible, which varies by your plan option. (see below). But, there is no deductible for preventive services, which can start right away. You will also pay copayments (e.g. $25 for doctor visits; $4 to $40 for most prescription drugs), and 20% of the costs of any other covered benefits you get. Your out-of-pocket costs cannot be more than $5,950 per year. These costs may be higher, if you go outside the plan’s network.

2011 Standard Plan - The 2011 Standard Plan now has two separate deductibles -- a $2,000 medical deductible and $500 drug deductible. The reduced pharmacy deductible is particularly helpful for people who take one or more maintenance medications.

2011 Extended Plan - The Extended Plan has a $1,000 medical deductible and $250 drug deductible plan. Like the Standard Plan, separating the drug and medical deductibles makes this option more valuable for enrollees with one or more maintenance medications.

Health Savings Account Option - The HSA Option has a $2,500 deductible and is eligible to receive favorable tax treatment by the federal government when used with a Health Savings Account (HSA).

Child-Only Rate -To ensure that children have more affordable access to coverage, HHS has established premiums targeted for covering children under PCIP, creating a child-only rate for PCIP enrollees between 0-18 years of age.
For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit and click on “Find Your State.” Then select Virginia from the map or drop-down menu. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604).

Health Care Information

In your work/discussions about health reform and ways to address the federal deficit without decimating federal health programs, here are some “home grown” resources that may be useful to you and your networks.

John McInerney’s (Commonwealth Institute) Op Ed regarding the importance of the federal “Maintenance of Effort Requirement” to protect current Medicaid and FAMIS eligibility.

My Op Ed on health reform and its impact/implementation in Virginia.

The Op Ed is a much abbreviated version of my commentary on the Affordable Care Act, which appears in the current issue of the Virginia News Letter, published by the University of Virginia's Weldon Cooper Center for Public Service.