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HHS on PCIP: Yes, We Need Agents

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WASHINGTON BUREAU — The U.S. Department of Health and Human Services is trying to save the struggling Pre-existing Condition Insurance Plan program by paying agents and brokers enrollment commissions.

HHS also plans to ease eligibility standards and cut the cost of participating in the program, officials say.

The PCIP provision of the Patient Protection and Affordable Care Act of 2010 (PPACA) was supposed to provide immediate relief for uninsured people with health problems, to help fill the gap PPACA toolkituntil insurers start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.

PCIP is supposed to provide comprehensive health coverage for people with health problems for a price similar to the price of ordinary individual commercial health coverage.

Eligibility is not based on income, and the risk pools cannot charge higher rates for people with more severe health problems.

Congress let states choose between running PCIP risk pools themselves or letting HHS provide PCIP risk pool services for their residents.

HHS now provides PCIP services in 23 states and the District of Columbia.

Program critics originally predicted that millions of uninsured Americans with health problems would rush to enroll in the program and quickly use up federal PCIP funding.

HHS officials estimate the program had a total of only about 18,000 enrollees nationwide

in March.

HHS will be leaving PCIP premiums the same in 6 jurisdictions where PCIP premiums are already well-aligned with premiums for conventional commercial health insurance, but realignment cut premiums by as much as 40% in the other 18 jurisdictions with federal PCIP services, officials say.

HHS also is easing the application process in the 24 jurisdictions with federal PCIP services.

Starting July 1, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, have had a serious medical condition, disability, or illness.

Applicants will no longer have to wait for a health insurance company to send them a denial letter, officials say.

HHS made that application option available to children under age 19 in February.

Applicants will still need to show that they are U.S. citizens or have resided in the United States legally and that they have been without health coverage for 6 months.

HHS also has sent letters today to the 27 states that run their own programs to let them know they can adjust their PCIP premiums, officials say.

Janet Trautwein, chief executive officer of the National Association of Health Underwriters (NAHU), Arlington, Va., has welcomed the HHS announcement.

“NAHU is thrilled,” Trautwein says. “NAHU supports that new PCIP program as a means of getting more people with serious health conditions covered in the most efficient means possible.”

The producer compensation changes will help NAHU members educate potential beneficiaries about the program and encourage enrollment, Trautwein says.

“As licensed and trained benefit specialists already working with consumers at the community level, agents and brokers are ideally well-suited to help HHS expanded consumer outreach to all uninsured Americans,” Trautwein says.

About 18 states already are working states to enroll individuals in the PCIP program, Trautwein says.

Other PCIP coverage from National Underwriter Life & Health: