Department of Financial Services, Consumer eViews Volume 7 Number 28
July 9, 2010
Sean
Shaw, Insurance Consumer Advocate
Navigating
the Patient Protection and Affordable Care Act (PPACA) can be a difficult task
without guidance. In the prior installments of the health care reform summer
series, issues relating to timing of various enactments were discussed. In
addition, the Office of the Insurance Consumer Advocate provided consumers with
information about grandfathering their health plan. In this edition, the Office
provides consumers with information about the newly established website and the
federal high risk pools that will become available to them as a result of the
Patient Protection and Affordable Care Act.
On July 1 the U.S. Department of Health and Human Services activated a web portal designed to assist consumers with obtaining information about insurance benefits that are available in their state. Also, the Pre-existing Condition Insurance Plan (PCIP) became available for people who have pre-existing conditions and cannot purchase insurance coverage in the private market. The new plan will provide health coverage options for consumers who have been uninsured for at least six months, have a pre-existing condition and have been denied health coverage because of their health condition, and are U.S. citizens or legal residents.
Also known as the high risk pool, Florida’s plan will be administered by a U.S. Department of Health and Human Services (HHS) contractor. Premiums will have to be paid, but will be subsidized by money allocated from the PPACA. For information on enrolling and available benefits, consumers should visit the newly established federal health care website http://www.healthcare.gov and click on “New Pre-Existing Condition Insurance Plan”.
The federal plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available to treat most pre-existing conditions. The plan will not charge a higher premium solely on the basis of medical conditions. Eligibility is not based on income, but rather on the denial of health insurance coverage by an insurer for the previous six months due to a pre-existing condition.
Consumers who are interested in participating in the high risk pool must complete the application at www.healthreform.gov. The application is available in PDF format in both English and Spanish. Applications received on or after the 15th of the month will likely go into effect on the first day of the next month.
As more information is available and additional changes become effective, the Office of the Insurance Consumer Advocate will generate advisories regarding their effects on consumers. More information regarding the PPACA can be found on the website of the Office of the Insurance Consumer Advocate at http://www.myfloridacfo.com/ica/federalhealthcare.asp.
The Insurance Consumer Advocate is appointed by Florida CFO Alex Sink and is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida’s diverse population and assuring that rates are fair and justified.