By Michael Grodsky, founder, Artist Insurance ServicesIf you are enrolled in California's PCIP (Preexisting condition Insurance Plan), your coverage is changing to the Federally-run PCIP as of July 1, 2013.
All PCIP and MRMIP plans will end as of January 1, 2014, because guaranteed coverage for all eligible persons becomes the law of the land. Open Enrollment begins October 1 for those new ObamaCare plans that will take effect January 2014. Click here to estimate how much it will cost you to purchase health insurance in 2014 and the amount of your financial assistance, if you are eligible for assistance.
Click here to subscribe to my Artist911 newsletter if you would like to kept informed about health insurance reform, educational events, and other interesting stuff. From July onward, I'll be hosting a webinar series and ground workshops in Los Angeles to educate folks about the upcoming changes and how to evaluate their options.
What to do if you are enrolled in PCIP
You can continue your PCIP coverage through December 2013 under the federally-run PCIP’s Transition Plan. This plan has a $1,000 annual medical deductible, and a $250 annual prescription drug deductible. After you have met the deductible, you will pay 30% of medical costs. For 2013, the maximum you will pay out-of-pocket for covered services in a calendar year is $3,125, or $5,000 for non-formulary prescriptions. Rates are below.
Rates for Federal PCIP Transition Plan
Age Monthly Premium Cost
0-18 ..........$117
19-34 ........$161
35-44 ........$287
45-54 ........$366
55+ ...........$505
Instructions from California PCIP that apply to currently-enrolled PCIP members.
Dear Subscriber:
We are writing to let you know about a change in the California PCIP Program. California has been one of 27 states running its own Pre-Existing Condition Insurance Plan (PCIP) program as a contractor for the Federal government, with the remaining 23 states and Washington, D.C. having their state's PCIP run by the Federal government beginning July 1, 2013, California will no longer operate the state's PCIP program. As a result, to continue your health coverage after June 30, you will need to activate a new PCIP benefit plan through the federally-run PCIP before July l.
How This Affects You
You will still have health coverage if you choose to enroll in the federally-run PCIP program. In June, you will receive an Enrollment Letter from the National Finance Center, which is the enrollment administrator for the federally-run PCIP. The Enrollment Letter will include information about the federally-run PCIP plan, how much it costs, and how to activate your coverage. You will not need to complete a new application to qualify for the federally-run PCIP. To activate your new coverage on July 1, and receive your PCIP ID card by that date, you must pay your first month's premium by the deadline stated in that letter. If you choose to do that, you will be a member of the federally-run PCIP program-joining more than 45,000 PCIP enrollees nationwide. You'll he enrolled in the Transition Plan and have a new benefits administrator.
You will still have health coverage if you choose to enroll in the federally-run PCIP program. In June, you will receive an Enrollment Letter from the National Finance Center, which is the enrollment administrator for the federally-run PCIP. The Enrollment Letter will include information about the federally-run PCIP plan, how much it costs, and how to activate your coverage. You will not need to complete a new application to qualify for the federally-run PCIP. To activate your new coverage on July 1, and receive your PCIP ID card by that date, you must pay your first month's premium by the deadline stated in that letter. If you choose to do that, you will be a member of the federally-run PCIP program-joining more than 45,000 PCIP enrollees nationwide. You'll he enrolled in the Transition Plan and have a new benefits administrator.
If you are in the course of treatment or if you have received prior-authorization for services, you will be mailed guidance about transition of care. It is critical that you follow required preauthorization of benefits procedures for hospitalization, durable medical equipment or supplies, transplants, skilled nursing, long-term acute care or rehabilitation facility admission, spinal fusion surgery or cancer treatment plans anticipated to occur on or after July 1. This is necessary even if you were already authorized with your current California PCIP.
You may have questions about how this transition will affect you; and along with our Federal partners, we will do our best to answer them. Information and resources will be available to you, including a program web site, plan materials, and a national toll-free Call Center staffed with trained specialists available to answer your questions. For more information on the federally run PCIP, you can go to www.pcip.gov or call 1-866-717-5826 Monday-Friday 5:00am to 8:00pm (TTY: 1-866-561-1604).
If you have not paid your June premium for California PCIP by May 30, 2013, please do so immediately or you will be disenrolled before the PCIP transition, If you have already pre-paid your July premium for California PCIP, any credits on account will be refunded. If you have a recurring credit card payment or an automatic electronic fund transfer to the California PCIP, we will discontinue those recurring payments draws from your account. Premiums paid to the California PCIP, including pre-paid premiums for future months, cannot be applied toward your premium in the federally-run PCIP program.
Beginning July 1, 2013, the California PCIP will no longer be operating except for paying claims for services that were already received. If you ha>·e questions about your existing California PCIP, you can call 1-877-428-5060 (Monday through Friday 8:00am to 8:00pm, Saturday 8:00 am to 5:00pm) or go to www.pcip.ca.gov.
Next Steps
In June. look for the Enrollment Letter in the mail from the NatiOnal Finance Center. It's very important that you act quickly on the instructions given in this letter. After you pay your premium, you will receive your enrollment packet from the federally-run PCIP benefits administrator, including your new PCIP ID card and details about your new benefits plan. You don't need to take any action right now. Just watch out for the letter in the mail, which will tell you exactly what you need to do to avoid losing your health coverage. We at California PCIP have been privileged to play a part in extending health coverage to you and more than 23,000 other Californians since it~ inception. We wish yon good health in the future.
In June. look for the Enrollment Letter in the mail from the NatiOnal Finance Center. It's very important that you act quickly on the instructions given in this letter. After you pay your premium, you will receive your enrollment packet from the federally-run PCIP benefits administrator, including your new PCIP ID card and details about your new benefits plan. You don't need to take any action right now. Just watch out for the letter in the mail, which will tell you exactly what you need to do to avoid losing your health coverage. We at California PCIP have been privileged to play a part in extending health coverage to you and more than 23,000 other Californians since it~ inception. We wish yon good health in the future.
Sincerely, California PCIP
Author BioMichael Grodsky, AIF, is founder of Artist Insurance Services, providing unbiased education and access to health insurance for Californians. He is a board member of Side Street Projects, a non-profit artist-run organization, and is an insurance and financial planning specialist for GYST, an artist-run company providing information and technology solutions for artists. Michael’s Health Insurance 101 workshops have been hosted by non-profit organizations throughout Los Angeles County. He leads the ‘Health Insurance 101’ monthly informational workshop at the Cancer Support Community-Benjamin Center.
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