Pennsylvania Pre-Existing Condition Insurance Plan (PCIP) 
Do you have a pre-existing conditionPATIENT FAQ 

The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition.  This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people if they have had a problem getting health insurance due to a pre-existing condition. 

How do I know if I am eligible for coverage through PCIP?*

Eligible individuals must:

  1. Is a resident of the Commonwealth of Pennsylvania
  2. Be a U.S. citizen or a legal resident: U.S. Citizens or U.S. Nationals must provide their Social Security Number.
  3. Have a pre-existing medical condition
  4. Not have been covered under health coverage for the previous 6 months before applying for coverage (proof of denial from insurance company will be needed)

How do I enroll?

Pre-Existing Condition Insurance Plan applications are online: https://www.humanservices.state.pa.us/Compass.web/MenuItems/FCSystemCompatibility.aspx

When will my PCIP coverage be effective?

On average, it takes four to six weeks for a PCIP application to be processed after the applicant’s 1st monthly premium payment has been received. Insurance benefits will be effective the first of the month following the month of eligibility determination.  

For example:  If the applicant enrolled between 8/13/2010, they are effective 9/1/2010.

How much does the Pre-Existing Coverage Insurance Plan cost me?

Individuals who are eligible will have a monthly premium of $283.20, plus copays and coinsurance.

What benefits do I receive under PCIP?

Covered In-Network Services:

  • $1,000 annual deductible (except for preventive services, which have no copay or deductible)
  • Patient pays 20% of the cost of covered benefits
  • Preventive services include: periodic health evaluations (ie. annual physicals), screening services (ie. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.
  • Yearly Out-of-pocket max at $5,000

*Persons currently covered by a health plan, including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for the Pre-Existing Coverage Insurance Plan. PCIP coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.

**Premiums may be subject to changes made by PCIP.

Hahnemann University Hospital | 230 N Broad St, Philadelphia, PA 19102