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The New Pre-Existing Condition Health Insurance Plan

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Congress passed and President Obama signed the Affordable Care Act — the new health insurance law.

The law creates a new program — the Pre-Existing Condition Insurance Plan — to make health insurance available to you if you have been denied coverage by private insurance companies because of a pre-existing condition.

The Pre-Existing Condition Insurance Plan (PCIP), which is administered by either your state or the US Department of Health and Human Services, will provide a new 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 US citizen or are residing here legally.

This program may be able to help you, if you’ve been locked out of the insurance market, until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. You can no longer be discriminated against based on a pre-existing condition.

The Pre-Existing Condition Insurance Plan will be available in every state — but the program may vary depending on your state. For years, many states have run programs  — often called “high risk pools”  – to offer insurance if you have a pre-existing condition.

To build on what states are already doing, states can either run the new program with resources made available by the Affordable Care Act, or rely on the US Department of Health and Human Services to provide coverage.

The program:

•Will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to you, even to treat a pre-existing condition.

•Won’t charge you a higher premium just because of your medical condition.

•Doesn’t base eligibility on income.

The US Department of Health and Human Services, with the help of the US Office of Personnel Management and the US Department of Agriculture’s National Finance Center, will run the Pre-Existing Condition Insurance Plan in some states. The federal government is contracting with a national insurance plan to administer benefits in those states. Other states have requested that they run the program themselves. The program may vary depending on what state you live in.