Getting Preexisting Coverage Easier

Physicians can help patients obtain immediate health insurance coverage for preexisting conditions, now that the federal government has relaxed eligibility requirements.

Previously, patients had to submit a letter from a private insurer denying coverage because of a preexisting condition before obtaining coverage under the Pre-Existing Condition Insurance Plan (PCIP). Now, patients can submit a letter from a physician, physician assistant, or nurse practitioner dated within the preceding 12 months stating that they have or had a medical condition, disability, or illness. The letter must include the patient's name and medical condition, disability, or illness, and the name, license number, state of licensure, and signature of the physician, physician assistant, or nurse practitioner.

PCIP is a health coverage option for patients who have been uninsured for six months or more due to a preexisting condition. Enrollees have a choice of three plan options: Standard Plan, Extended Plan, or HSA Plan. Each plan has different premium costs, calendar year deductibles, prescription deductibles, and prescription copays.

The plans:

  • Cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs; 
  • Do not charge a higher premium because of a person's health condition; and
  • Do not base eligibility on income. 

The Texas Department of Insurance (TDI) says rates for the three insurance options under the plan were reduced 23.6 percent on July 1. PCIP rates are based on age, but there is no age limit for coverage, TDI said, adding that the maximum annual out of-pocket cost is $5,950 for in-network and $7,000 for out-of-network care. PCIP rates are lower than those in the Texas Health Insurance Pool, which also is for patients with preexisting conditions, and there is no exclusionary period for preexisting conditions. Complete coverage is available immediately. 

For more information, call the Texas Consumer Health Assistance Program at (855) 839-2427 or click here  


Action, July 19, 2011


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