Help Patients Get Preexisting Condition Coverage

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; the 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.

In Texas, PCIP is provided by the U.S. Department of Health and Human Services and administered by GEHA.

Revised Sept. 26, 2011


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