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HHS to Reduce Premiums, Simplify Enrollment for Individuals with Pre-Existing Conditions

Americans with pre-existing health conditions will now have an easier time getting health insurance.

HHS has announced plans to reduce premiums and make it easier for Americans to enroll in the pre-existing condition insurance plan (PCIP). Under the plan, PCIP premiums will drop as much as 40 percent in 18 states where the federally administered PCIP operates, and eligibility standards will be eased in 23 states and the District of Columbia to ensure that more Americans with pre-existing conditions have access to affordable health insurance.

Starting July 1, 2011, 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, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter. This option became available to children under age 19 in February, and this pathway is being extended to all applicants regardless of age. Applicants will still need to meet other eligibility criteria, including that they are United States citizens or residing in the U.S. legally and that they have been without health coverage for six months.

The HHS also informed the 27 states running their own PCIP programs that they can modify their current PCIP premiums.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but not enrolled.

The PCIP was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition like cancer, diabetes, and asthma.


Source: U.S. Department of Health and Human Services, May 31, 2011

Health Reform 2011: Impact on Health Plans, Hospitals, Providers and Purchasers

In this valuable resource, insiders close to HHS and in leadership positions at health plans, provider organizations and PBMs identify the strategic impact of the reform law across all sectors of the industry, and the business implications and compliance issues raised by new rules covering dozens of topics — from dependent coverage expansions and high-risk pools to bans on pre-existing condition exclusions and annual and lifetime limits.

Health Reform 2011: Impact on Health Plans, Hospitals, Providers and Purchasers is available from the Healthcare Intelligence Network for $141 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.

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IMPORTANT NOTICE: This information is designed to provide accurate and authoritative information on the business of healthcare. It is distributed with the understanding that Healthcare Intelligence Network is not engaged in rendering legal advice. If legal advice is required, the services of a competent professional should be retained.

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