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July 08, 2010 at 08:00 PM
The new Pre-existing Condition Insurance Plan (PCIP) may be cheaper than the existing Illinois risk pool, but switching programs is a bad idea, officials say.
The Illinois Department of Insurance and the Washington Insurance Commissioner Mike Kreidler have come out with new advice about the PCIP program, and Illinois officials are especially blunt their guidance, which is formatted as a collection of answers to frequently asked questions about the PCIP program.
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 – provided $5 billion in PCIP funding to fill in coverage gaps for uninsured people with health problems before a ban on medical underwriting takes effect in 2014.
The District of Columbia and 29 states decided to run their own risk pool plans, and 21 states have decided to leave risk pool coverage in the hands of HHS officials.
Many states already have risk pool programs to provide coverage for residents who are not considered to be healthy enough to buy conventional individual health insurance in those jurisdictions.
Illinois has been running the Illinois Comprehensive Health Insurance Plan (ICHIP) risk pool since the late 1980s.
State law requires ICHIP premiums to be at least 125% of the standard rate and not more than 150% of the standard rate. “Illinois law requires that premiums be based on sex, age, geography, and specific benefit plan,” officials say.
Illinois expects to get about $196 million in federal PCIP funding, and it is hoping it can use that funding to provide risk pool coverage for 4,000 to 6,000 additional individuals, officials say.
“Variables that impact how many people can enroll include (1) the severity of the illnesses of those who enroll, (2) the benefit structure, and (3) the length of the coverage term,” officials say.
The ACA PCIP provisions require PCIP premiums to be comparable to commercial premiums, and age, geographic location and tobacco use are the only factors that a PCIP program can use when setting rates, officials say. For PCIP enrollees, the rate for the oldest enrollees can only be 4 times as high as the rate for the youngest enrollees.
To qualify for PCIP coverage, an Illinois resident must have a preexisting condition and go without health coverage for 6 months.
