Diabetics can receive full coverage health benefits in the federal PCIP.
Beginning in 2014, the Patient Protection and Affordable Care Act of 2010 will put a halt to common health insurance industry practices that deny or limit coverage options to individuals with high risk health conditions. Until that time, the law requires states to offer their residents access to pre-existing condition insurance pools, or PCIPs -- either through state-sponsored insurance pools or by participating in the federally organized PCIP. Idaho opted to participate in the federal PCIP, providing Idaho residents living with high risk medical conditions with access to comprehensive benefits.
Coverage
Those enrolled in an insurance plan as a part of the federal high risk health insurance pool receive wide-ranging coverage for a variety of health needs and services, including existing medical conditions. All insurance plans available through the program feature benefits for hospital care, primary care, emergency services, prescription drug coverage and specialty care. Coverage begins immediately upon enrollment, and there are no waiting or exclusion periods applicable for any medical condition.
Plan Options
In January 2011, the federal PCIP revamped insurance availability in Idaho, offering three health insurance options for PCIP enrollees. Two of the health insurance plan options are traditional health insurance, with monthly premiums ranging between $133 to $571 per month, depending on the plan selection and the enrollee's age and a tax-sheltered health savings account, or HSA attached to a qualifying high deductible insurance policy. In the latter, policyholders may pay for all cost-sharing and qualified medical expenses -- including deductibles -- with non-taxable income. Premiums for the HSA range from $138 to $441 per person. Preventive care, like annual physicals, inoculations and screenings, is covered at 100 percent with no deductible.
Qualifications
To qualify for the pre-existing condition insurance pool, applicants must have proof of a denial of health insurance due to an existing medical condition. Additionally, applicants must have no health insurance coverage for at least six months before applying to the federal high risk insurance pool. The U.S. Department of Health and Human Services will deny the application of any person who is not either an American citizen or a qualifying legal U.S. resident.
Other Options
Individuals with existing medical conditions and the option to participate in a group insurance program may find assistance through the Health Insurance Portability and Accountability Act. HIPPA limits coverage denials for employer group health insurance policies. Once an employee qualifies for health insurance through a group insurance plan, insurers can only exclude coverage for a pre-existing medical condition for up to 12 months following enrollment or up to 18 months following a late enrollment.
Tags: health insurance, high risk, existing medical, federal PCIP, insurance plan, insurance pool
