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Life Health > Health Insurance > Your Practice

CMS Adding Producer Field to PCIP Form

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Managers of the Pre-existing Condition Insurance Plan (PCIP) program are revising the PCIP application to include information about the agents or brokers who have helped consumers sign up for coverage.

The Centers for Medicare & Medicaid Services (CMS), an arm of the U.S. Department of Health and Human Services, talks about the application change in a PCIP application form revision notice that appears today in the Federal Register.

The Paperwork Reduction Act of 1995 requires CMS and other federal agencies to publish descriptions of proposed collections of information for public comment.

The Center for Consumer Information and Insurance Oversight (CCIIO), the CMS division that runs the PCIP program, intends to add “a mechanism whereby a licensed insurance agent or broker may identify their referral of an applicant,” officials say.

The revised application also will provide a mechanism that a PCIP applicant can use to have another party entity pay their premiums, and it will “request employer information to expand ways to identify and prevent instances of insurer dumping,” officials say.

The PCIP provision of the Patient Protection and Affordable Care Act of 2010 (PPACA) is supposed to provide immediate access to coverage for uninsured people with health problems, to help fill the gap until PPACA calls for insurers to 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. The federal government is now providing PCIP services for 23 states and the District of Columbia; 27 states are running their own PCIP programs.

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.

The program ended April with only 21,454 enrollees, according to the National Conference of State Legislatures, Denver.

Critics charged that one reason for low enrollment might be that agents and brokers have had no financial incentive to tell consumers about the program. HHS officials announced earlier this year that they would try to boost participation by paying producers a finder’s fee.

Other PCIP coverage from National Underwriter Life & Health:


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