New York state now has an active Pre-existing Condition Insurance Plan (PCIP), the NY Bridge Plan.
In July, New York officials said they were hoping the New York PCIP program premiums would be less than $600 per month. The actual premiums will be just $362 per month in upstate counties and $421 per month in downstate counties, including counties in New York City, officials say.
The initial plan design includes a $20 office visit co-payment, a $500 co-payment per inpatient stay and a $100 emergency room co-payment, officials say. The package also includes pharmacy benefits and vision care benefits.
The NY Bridge Plan administrators will process applications on a first-come, first-service basis, officials say. The earliest coverage can take effect is Oct. 1. Once the NY Bridge Plan reaches capacity, administrators will set up a waiting list.
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 – allocated $5 billion to the PCIP to fill in coverage gaps that will exist before a ban on medical underwriting takes effect in 2014.
The PCIP program is supposed to provide “uninsurable” individuals access to coverage at rates comparable to individual rates in the commercial market. The program is open to individuals with serious pre-existing conditions who have been uninsured for at least 6 months
Some states are letting the new federal Office of Consumer Information and Insurance Oversight run their PCIP programs, but a majority will be running their own risk plans. New York is expecting to use $297 million in PCIP funding to provide temporary coverage for about
15,000 state residents, officials say.
New York already requires insurers to sell conventional coverage to people with pre-existing conditions on a guaranteed-issue, community-rated basis. Instead of making coverage available to residents who cannot buy coverage at all, the NY Bridge Plan will be offering coverage at unusually low, subsidized rates.
The Congressional Budget Office has estimated that, if Congress sticks with current funding levels, the PCIP system as a whole will have about enough funding to provide coverage for about 200,000 uninsured U.S. residents with serious health problems, or about 3% to 4% of the 5.6 million Americans who might be eligible to participate.
ACA provisions require a state’s PCIP program manager to be a nonprofit organization, and GHI, a unit of EmblemHealth Inc., New York, is the only nonprofit company authorized to operate statewide in New York state, officials say.
Program applicants can document that they have serious health problems by submitting letters from doctors, current medical records or online personal health records.