Are you no longer eligible for benefits under a group health plan? Have your COBRA benefits been exhausted? Have you been denied coverage due to a preexisting condition? Finding individual health coverage can be discouraging, especially when you have a health condition. But this post is about throwing you a lifeline. Texas is among many states which offer the Pre-Existing Condition Insurance Plan (PCIP), a federally funded insurance plan which offers insurance to people with ongoing or chronic medical conditions, at prices that are now more affordable.
These plans offer a broad range of coverage, including primary and specialty care, hospital care and prescription drug coverage. Maximum annual out of pocket cost for covered services is $5950 for network services and $7000 for out-of-network care. With a little help from the federal government, annual premiums are on the decline. Kathleen Sebelius, Secretary of Health and Human Services, announced recently that premiums have been reduced 10-20% in Texas. Similar cuts were made in Georgia, Indiana, Louisiana, Mississippi, Nebraska, South Carolina, Tennessee, West Virginia and the District of Columbia. Even greater cuts, some up to 40%, were made in Alabama, Arizona, Delaware, Florida, Kentucky, Minnesota, Nevada and Virginia. And, most remaining states have opted to take this federal money and design their own similar programs. So, no matter where you reside, you should be able to find a plan to fit your needs without denial from a reputable insurance company.
You may be eligible for the PCIP if you:
- Have been without health coverage for at least six months
- Have a preexisting condition or have been denied health coverage because of a health condition
- Are a U.S. citizen or reside in the U.S. legally
To apply for coverage in Texas, you must provide proof of residency and proof that you have been denied coverage. Proof of coverage denial may be a doctor's letter dated within the last 12 months, a denial letter from a Texas-licensed insurance company, a letter of ineligibility from a Texas-liscensed agent or insurance company, or an offer of coverage that excludes one's preexisting condition.
Getting the protection you need is simple. Apply online at www.pcip.gov, or visit the website to print out the application and submit it by mail or fax.
For questions about this and other state and federally supported insurance plans, you may contact the Texas Consumer Health Assistance Program (CHAP); they have the resources to help you when you need it the most. Contact 1-855-TEX-CHAP, Monday through Friday, from 8 am to 5 pm CST, or go online at www.TexasHealthOptions.com.
If this post helped you or a former employee looking for assistance ... please let us know. It is important for us to hear feedback when information we publish helps others.
Sources: Dallas Morning News, TDI Newsletter