Florida Pre-Existing Condition Insurance Plan (PCIP) 
Do you have a pre-existing conditionPATIENT FAQ 

The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition.  This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people if they have had a problem getting health insurance due to a pre-existing condition. 

How do I know if I am eligible for coverage through PCIP?*

Eligible individuals must:

  1. Be a U.S. citizen or a legal resident
  2. Have a pre-existing medical condition
  3. Not have been covered under health coverage for the previous six months before applying for coverage (proof of denial from insurance company will be needed)

How do I enroll?

You can enroll for the Pre-Existing Condition Insurance Plan online at www.pcip.gov, or call the PCIP customer service department toll-free at (866) 717-5826 (TTY 1-866-561-1604) and ask for an application.

When will my PCIP coverage be effective?

A completed PCIP application received on or before the 15th of the month will go into effect on the first day of the next month. A completed application received after the 15th of the month will go into effect on the first day of the following month.  For example: If the applicant enrolled between 8/1/2010-8/15/2010, they are effective 9/1/2010, and if they enroll between 8/16/2010 and 8/31/2010, they are effective 10/1/2010.

How much does the Pre-Existing Condition Plan cost me?**

Monthly Premium: Florida

Age

Standard Option

Extended Option

HSA Option

0 to 18

$196

$263

$203

19 to 34

$294

$395

$305

35 to 44

$352

$474

$366

45 to 54

$450

$605

$467

55+

$626

$842

$650

What benefits do I receive under PCIP?

Covered In-Network Services:

  • $1,000 - $3,000 annual deductible (except for preventive services, which have no copay or deductible), varies by plan option
  • Patient pays 20% of the cost of covered benefits
  • Out-of-pocket costs capped at $5,950 per year
  • No lifetime maximum
  • Preventive services include: periodic health evaluations (ie. annual physicals), screening services (ie. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.

*Persons currently covered by a health plan, including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for the Pre-Existing Condition Insurance Plan. PCIP coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.

**The following link provides complete detail on all covered services, including all preventive services and member out of pocket responsibilities http://www.pciplan.com/forms/pdfs/brochure.pdf; premiums may be subject to changes made by PCIP.