Reform Alert - News from the Blues' Office of National Health Reform

Pre-Existing Condition Insurance Plan extended

Dec. 30, 2013

On Dec. 12, the Centers for Medicare and Medicaid Services announced that the Pre-Existing Condition Insurance Plan (PCIP) has been extended one month.

The temporary high-risk pool program, which provides coverage to about 135,000 people, was scheduled to close Dec. 31, 2013. The plan has been extended for those who haven’t obtained new coverage because of enrollment issues with the Marketplace website.

Beginning July 1, 2013, Michigan transferred its state-run PCIP enrollment to the federally run PCIP program.

The federally run PCIP stopped accepting new applications on Feb. 16, 2013, to stretch the $5 billion appropriation for the program until Dec. 31.

On Dec. 13, CMS released the PCIP Report of Expenditures and enrollment figures.

The report details spending as of Sept. 30, 2013. These figures reflect claims and administrative costs paid. They do not reflect costs that are acquired but not reported.

Michigan expenses after the July 1, 2013, transition:

  • Enrollment as of Sept. 30, 2013: 1,798 enrollees
  • Claims paid as of Sept. 30, 2013: $109,717,056
  • Administrative expenses paid as of Sept. 30, 2013: $2,607,422
  • Expenditures net of premium revenue as of Sept. 30, 2013: $101,009,950

Federal program costs incurred by Michigan after the July 1, 2013, transition:

  • Enrollment as of Sept. 30, 2013: 1,798 enrollees
  • Claims paid as of Sept. 30, 2013: $4,041,937
  • Administrative expenses and expenditures net of premium revenue were not available for the federally run states.

The State-by-State Enrollment in the PCIP was updated to reflect enrollment as of Oct. 31, 2013. In Michigan a total of 1,715 individuals are enrolled in PCIP out of a total of 85,798 enrollments nationwide.

Where can I find more information?

More information can be found in the report.

The information in this document is based on preliminary review of the national health care reform legislation and is not intended to impart legal advice. The federal government continues to issue guidance on how the provisions of national health reform should be interpreted and applied. The impact of these reforms on individual situations may vary. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. As required by US Treasury Regulations, we also inform you that any tax information contained in this communication is not intended to be used and cannot be used by any taxpayer to avoid penalties under the Internal Revenue Code.

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