PCIP.gov - Strange Application Wording

[AllenChicago]

Here is a link to the official U.S. Government PCIP enrollment form:

http://www.pcip.gov/PreExistingConditionPlan_EnrollmentForm_063010_508.pdf

On page 2 it says that you can get this plan if you were offered a health insurance policy in the last 6 months that included an exclusion rider for a medical condition(s).

I thought that you had to be Uninsured for 6 months prior to applying.

Also, I don't see the premiums anywhere at PCIP.gov - Home . So what do people do... apply, get an offer in xx weeks and then mail in their premium? There seems to be a lot of important consumer-support information missing.
-Allen

 

[somarco]

I noticed the same thing which is why I am referring folks to PCIP even if they have had insurance (such as COBRA) in the last 6 months. According to the way the app is worded, if you were offered a plan with a rider you can qualify for PCIP. The policy would need to be issued so you can send a copy of the rider with your PCIP app.

Even if you sent it back under the (presumably) 10 day free look, you had insurance for those 10 days which would/should make you ineligible for PCIP.

Rates are here.

Last week I referred a lady there who did not have insurance and had not had any for over a year. Her BMI was 40+. She called to say the premium was over $300/mo and she could not afford that.

Change you can believe in.

 

[Crabcake Johnny]

Bet you she also can't afford to pay the OOP for office visits before the doctor copay kicks in:

In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you've met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan's network. See below for a benefits summary.

 

[CHUMPS FROM OXFORD]

"Covered in-network services are subject to a $2,500 annual deductible (except for preventive services)"

Wow. I'm sure most people have no idea.

 

[Crabcake Johnny]

Right...so $2,500 before they get doc visits or meds so you take a 50 year old with a $550/mo premium and he has to spend $9,100 before the copays kick in.

 

[AllenChicago]

I noticed the same thing which is why I am referring folks to PCIP even if they have had insurance (such as COBRA) in the last 6 months. According to the way the app is worded, if you were offered a plan with a rider you can qualify for PCIP. The policy would need to be issued so you can send a copy of the rider with your PCIP app.

Rates are here.

Somarco, thanks for your input regarding "Ridered" insureds being accepted on the PCIP.

And thanks for the rates page too. I had no idea where to find it. It's strange that the next to last paragraph ends with the words, "See below for a benefits summary". There is no benefits summary anywhere on that page. A health insurance plan with no outline of coverage available for the public to inspect!? If a private health insurance company did this, the FEDS would fine them and shut them down really fast.

Here in Illinois, the state has chosen to set up it's own government subsidized plan. They won't even begin taking applications until late August.. at the earliest. I wonder what the motivation is for a State to do what the FEDS have offered to do? A power/control thing? Stupid decision for Illinois considering that this State has a huge budget deficit already.
-AC

 

[somarco]

Any state that agreed to set up a 3 yr plan is nuts. They should have let the feds run it. Now when the state runs out of money the feds have sent to pre-fund this what happens? Do they just tell the people sorry?

There is no sane reason for any state to follow DC down this path to stupidity. All 57 states should have hung the feds out to dry.

 

[TXINSURANCE]

Can you please name the additional 7 states for me?

 

[somarco]

Ask Obama. He was the one who visited 57 states during the campaign.

 

[AllenChicago]

Any state that agreed to set up a 3 yr plan is nuts. They should have let the feds run it. Now when the state runs out of money the feds have sent to pre-fund this what happens? Do they just tell the people sorry?

There is no sane reason for any state to follow DC down this path to stupidity. All 57 states should have hung the feds out to dry.

Hey Somarco, I just noticed that you have over 10,000 posts to this forum! WOW. R-U a founder? I hope so, or else the owners might send you a bill for bandwidth utilization.