In August, eligible residents of Washington will be able to apply for coverage through the state’s pre-existing condition insurance plan program (PCIP) run by the Washington State Health Insurance Pool.

The plan is made possible by the new federal health care plan which will be providing $102 million to Washington for its PCIP. The program is meant to cover those individual who currently can’t get private insurance due to existing conditions.

Created under the Affordable Care Act, PCIP is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions and individuals and small businesses will have access to more affordable private insurance choices through new competitive exchanges. In 2014, Members of Congress will also purchase their insurance through exchanges.

“For too long, Washington residents with pre-existing conditions have been locked out of our health insurance market,” said U.S. Secretary Kathleen Sebelius in a press release. “Today, the pre-existing condition insurance plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”

The Affordable Care Act provides $5 billion in federal funding to support pre-existing condition insurance plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their PCIP. Other states, like Washington, have requested that they run the program themselves. 

To qualify for coverage:

1. The applicant must be a U.S. citizen or lawfully present in the United States.

2. The applicant must have been uninsured for at least the last six months before you apply.

3. The applicant must have had a problem getting insurance due to a pre-existing condition.

The pre-existing condition insurance plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  All covered benefits are available for the applicant, even if it’s to treat a pre-existing condition.

There are two deductible plans being offered:

Plan 1:  $2,500

 Plan 2:  $500

Out of Pocket Limit:

Plan 1, medical:  $4,950 in-network, $7,400 out-of-network

Plan 1, pharmacy:  $1,000

Plan 2, medical:  $1,000 in-network, $2,000 out-of-network

Plan 2, pharmacy:  $500

The premium will range from $177 to $1,577 per month. The costs vary depending upon deductible, age and whether or not the applicant smokes. For example, someone between 50 and 59 would pay $563 if he/she did not smoke, $653 if he/she did on the higher deductible.

The $500 deductible would cost $1,157 for the non-smoker and $1,342 if they smoke.

For more information, call 800/562-6900 or go to www.insurance.wa.gov/consumers/health/preconditionplanwa/aboutplan