Pre-existing condition? Check out PCIP

Dennis DalmanColumnLeave a Comment

If you’ve ever had a bout with cancer, as I have, you know how virtually impossible it is to find an insurance plan that is even remotely affordable, unless you’re rolling in dough. And who is these days?

About a year ago, I had a cancerous growth removed from one of my vocal cords. I was lucky. It was early-stage. After surgery, I was home the same day with a slightly sore throat. No chemo, no radiation required. Very lucky.

But last summer, when my health-coverage ended, I did not feel so lucky. I began to worry about how I could afford a new insurance policy. I shopped around, but they were all out of my range.

Fortunately, a good friend told me about a little-known insurance program that covers those with pre-existing conditions, that is reasonable and provides very good coverage. My friend also went through a battle with cancer a couple years ago; he, too, was worried about insurance. He was fortunate to find this new one, in time for another bout with a different kind of cancer. The last one, too, was a victorious bout, I’m happy to report.

My friend sent me information about that excellent insurance plan, and I plan to apply for it very soon. He said the plan is so little-known, he asked me to share details about it with my readers, which I am so happy to do.

It is called the Pre-Existing Insurance Plan. Administered by the Government Employees Health Association, it was created as part of the nation’s new health-insurance law, the Affordable Care Act, created by the Obama Administration. To join the plan, you must have been denied coverage by private insurance companies because of a pre-existing condition; or if you have been uninsured for at least six months and are on record as having a pre-existing condition. PCIP is only a transitional program until 2014 when the Affordable Care Act will be more fully implemented nationwide.

The PCIP is not a family-coverage plan; it covers only the individual with the pre-existing condition. Each enrollee can choose from three coverage plans – Standard Option, Extended Option, Health Savings Account Option. The premiums depend upon five age groups, the lowest from 0-18, the highest 55 and above. Monthly premiums for the year 2012 have been set at from $96 for Standard Option (ages 0-18) to $307 for Standard Option (age 55 and above). For Extended Option (age 55 and above) the monthly premium is $414, which is the highest premium of the 15 premium prices on the chart.

Each of the three plan options provides preventive care paid at 100 percent with no deductible when you visit an in-network doctor. Included are annual physicals, flu shots, cancer screenings and routine mammograms. After your deductible is paid, you pay 20 percent of costs in-network. For 2012, the maximum you will pay out-of-pocket for covered services is $4,000 (or $6,050 if you choose the HSA Option). There is no lifetime maximum or cap on the amount the plan pays for your care.

Of course, the option you choose will depend upon your medical condition, your needs and your expectations. You’ll also want to check out a list of providers for your area. You can access them on the website or via a phone number given on the website.

I highly recommend those of you with pre-existing conditions check out the PCIP website. It is easy to follow, easy to understand and easy to apply.

Go to

Then, under Premium Rates, you will see a series of states. Click on “Minnesota.”

Good luck. If this column can help even one reader obtain affordable insurance in these tough times, I will be happy. And to my friend, thanks for sharing this good news with me and my readers.

Author: Dennis Dalman

Dalman was born and raised in South St. Cloud, graduated from St. Cloud Tech High School, then graduated from St. Cloud State University with a degree in English (emphasis on American and British literature) and mass communications (emphasis on print journalism). He studied in London, England for a year (1980-81) where he concentrated on British literature, political science, the history of Great Britain and wrote a book-length study of the British writer V.S. Naipaul. Dalman has been a reporter and weekly columnist for more than 30 years and worked for 16 of those years for the Alexandria Echo Press.

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