The U.S. Department of Health and Human Services has unveiled the new, national temporary health insurance risk pool program, the Pre-existing Condition Insurance Plan.
The federal Affordable Care Act (ACA) – the legislative package that includes the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act – is set to prohibit medical underwriting in the individual market starting with plan years that begin in 2014.
In states that permit individual market medical underwriting, the PCIP program will offer “uninsurable” individuals access to coverage before the national medical underwriting ban kicks in.
Congress included $5 billion in ACA funding to expand risk pool access. In many states that already have risk pools, budget constraints have forced managers to stop enrolling new members. Managers of some existing risk pools have been stretching funding by charging high rates or putting tight limits on benefits.
The District of Columbia and 29 states have decided to run their own risk plans, and 21 states will have the new federal Office of Consumer Information and Insurance Oversight (OCIIO) manage their PCIP coverage.
All states that will run their own risk plans are supposed to start enrolling applicants by the end of the summer, and many are beginning enrollment today, officials say.