Pre-Existing Condition Insurance Plan
7/8/10. Submitted by Jeff Tomlinson
The federal health care reform law contains a provision for the creation of a statewide insurance pool for uninsured high risk individuals, who are people with medical conditions that are expensive to treat. New York has applied to the U.S. Department of Health and Human Services for federal funding for the high risk pool, which is called the Pre-Existing Condition Insurance Plan. The Federal government has guaranteed that no financial responsibility for this program will be shifted to the states. The program will begin in 2010 and will last until more comprehensive coverage options become available through a Health Insurance Exchange in 2014.
New York has requested that Group Health Incorporated (GHI) serve as the designated nonprofit contractor to operate a qualified high risk pool on behalf of the State. By Federal rules, only a nonprofit can serve in this role. GHI is a subsidiary of Emblem Health and is the only nonprofit company authorized to operate statewide in New York State. GHI's statewide network of participating providers will make it easier to facilitate access for care for New Yorkers all around the State.
This program was designed to be affordable while also offering comprehensive coverage. The Pre-Existing Condition Insurance Plan is required to cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Plan will not base eligibility on income and does not charge a higher premium because of a pre-existing medical condition.
To ensure access to needed care, the program will include low co-pays as well as services that will assist enrollees in managing chronic conditions and maintaining overall health. The program is expected to enroll about 15,000 New Yorkers.
The Federal funds will cover any operational costs and also subsidize premiums, which will be well below the current cost of coverage in the individual market. The State's goal is to have premiums below $600 a month. The cost of the insurance premiums to individuals and the start date depend on Federal approval. Assuming timely approval of New York's application, New York hopes to begin accepting applications by August 15, 2010, with coverage available by the late fall.
