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HHS unveils insurance program for those with pre-existing conditions

by Brendon Nafziger, DOTmed News Associate Editor | July 02, 2010
A transition plan for those
with pre-existing conditions
Patients denied health insurance coverage because of a pre-existing condition now have refuge in a new government-funded plan.

The U.S. Department of Health and Human Services announced Thursday it had launched one of the key components of the Obama administration's health care reform, the Pre-Existing Condition Insurance Plan.

Under this plan, patients who have been uninsured for at least six months because of a pre-existing medical condition can sign up with a federal- or state-administered government insurance plan.

In most states, in order to be eligible for the plan patients will have to provide evidence of a denial letter from an insurance company as well as their medical condition, according to a government brochure. The plan is not means-tested, the HHS said.

Premiums for the plan will not be higher because the patient has a medical condition, and will be similar to standard individual health plans in the patient's state, the HHS said.

"For too long, Americans with pre-existing conditions have been locked out of our health insurance market," HHS Secretary Kathleen Sebelius said in a statement. "This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014."

In 2014, under the Affordable Care Act, private insurers will be forbidden to discriminate against adults with pre-existing conditions. But children with pre-existing conditions will receive some protection in September.

The HHS pre-existing plan will expire in 2014, an HHS spokeswoman told DOTmed News, as it is intended only to be a bridge providing temporary relief until private insurers start covering those with pre-existing conditions and government-run insurance exchanges appear.

The plans are being funded with $5 billion earmarked by the Affordable Care Act. Although the federal government is footing the entire bill, HHS gave states the option of setting up and running their own plan if they didn't want to have it managed by the HHS. Twenty-one states joined the HHS plan, while 29 states and the District of Columbia have their own, the HHS said.

All states with plans managed by the HHS began accepting applications for insurance Thursday.

"In states running it themselves, some started today, but all will begin by the end of the summer to accept applications," an HHS spokeswoman said.
States administering their own plan include Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Maine, Maryland, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington State, West Virginia and Wisconsin.

States accepting HHS' management include Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia and Wyoming.