Good Neighbor Insurance, dev.gninsurance.com, is continuing to update our clients on the new health insurance laws. There are six major coverage options for those in the US and even though some of the rules and regulations are similar for all many differences are there and it all depends on how old you are and for whom you work. Many critical details of this new insurance law will be clarified in the months and years to come.
These six major coverage options are:
(1) Individual or family coverage (private health care plans)
(2) Employee/employer group option for small businesses (typically under 50 employees)
(3) Employee/employer group option for large businesses (typically larger than 50 employees)
(4) Exchange options through the state you are residing in (fully integrated 1-1-2014 and are quasi-government and private insurance coverage combined)
(5) Medicare (which include Parts A, B, C, and D) for those 65 years onwards
(6) Full government health plans like Medicaid, CHIP, TRICARE, VA and other coverage plans as may be designated by the Department of Health and Human Services based mostly on financial criteria and/or military.
PCIP = Pre-existing Condition Insurance Plan also called the federal high risk (pool) insurance plan
The new government pre-existing condition insurance plan (PCIP or also called the federal high risk pool) is the new health plan through the federal government that President Obama signed into law back in March of 2010.
Here are some 2011 year highlights since this federal high risk health pool insurance option has started:
1. 48,879 enrollees to date (December 2011)
* Enrollment is running far below expectations, the PCIP designers have stated.
2. Enrollees are averaging $29,000 in claims per year in the federal PCIP plan.
* Twice the average of traditional state high risk pools.
3. State high risk plan comparison over the federal PCIP high risk plan:
* In Colorado, as an example, the average state high risk pool has 137 hospital admissions /1,000 enrollees per year.
* The hospital rate for the PCIP plan in Colorado is 562 admissions per 1,000 per year.
4. Another example of state high risk plan over the federal PCIP high risk plan is in Kansas.
* Kansas state risk plan average $1,376 per month of claim expenditures per enrollee.
* PCIP federal high risk plan average $3,449 per member of claim expenditures per month.
5. PCIP federal high risk program does not charge higher premiums because of the policyholder’s medical condition. Premiums do vary only on the basis of:
* Geographic area
* Tobacco use
6. The PCIP federal high risk program, even though it is in the ‘red’ financially, is able to stay in the ‘black’ by being bailed out through the federal taxes paid by U.S. citizens/residents.
7. About half of the states are administering their own PCIP program instead of allowing the federal government to run their PCIP high risk plan.
* The states with the highest PCIP federal high risk plan enrollment are:
8. To keep the PCIP federal high risk plan from overcrowding other private and public health coverage, Congress requires that all PCIP enrollees be individuals who have gone without health insurance, including state risk pool plans, for at least six months.
9. There is no waiting periods for pre-existing conditions to be covered on the PCIP federal high risk pool. Once accepted all medical conditions are covered.
10. To learn more about the federal PCIP high risk plan please go to http://www.pciplan.com/.
Keep our blog close by you, www.gntravelinsurance.com, for continual updates on the changes with the U.S. health care system. Doug Gulleson loves to scuba dive at Lembeh Dive Resort in Indonesia. He makes sure he has his U.S. health care and overseas travel adventure sports insurance, www.gninsurance.com/extreme-sports, with him at all times.