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Your patients with pre-existing conditions have a new option
e-Reports, September 7, 2010
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A message from ISMA Past President Vidya Kora, M.D.
One of the many compelling reasons that led to the passage of health care reform legislation was the difficulty people with pre-existing conditions were having obtaining health insurance.

Starting this year, the health care legislation prohibits insurance companies from denying health insurance to children with pre-existing conditions.

In 2014, the health care bill will also prohibit insurance companies from denying coverage to adults with pre-existing conditions, and those adults and everyone else will have the option of buying health insurance through health insurance exchanges to be set up in each state by 2014.

To help people with pre-existing conditions who are unable to obtain insurance between now and 2014, the federal government created a temporary high-risk pool called the Pre-existing Condition Insurance Plan (PCIP).

The legislation gave states the option of either taking the federal money and expanding their existing high-risk pool or letting the federal government run the high-risk pool in their states. Indiana opted for U.S. Health and Human Services to run our PCIP.

Indiana has had a high-risk pool since 1982. It covers more than 6,000 people and is partly subsidized by the state. The 2010 average monthly premium is $712 with a $1,000 deductible.

The new federal plan will give Hoosiers with pre-existing conditions another choice. The monthly premium is expected to be around $500, a savings of about 25-30 percent compared to the existing state high-risk insurance. The new plan will cover physician visits – both primary and specialty care – hospital care and prescriptions.

To be eligible for the PCIP, people must:

  1. Be U.S. citizens or legal residents
  2. Have been denied health insurance because of a pre-existing condition
  3. Have been without insurance for six months

Those who meet these criteria and want this insurance can obtain an application by calling (866) 717-5826, or they can download an application from the healthcare.gov website.

Health care is an extremely important and complex issue. As more people learn the facts, rather than relying on rhetoric and sound bytes, they and their families will become better educated and better served.

Printed at the request of ISMA Past President Vidya S. Kora, M.D. Responses or other articles (of 350 words or less) from members will be published as space permits.

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