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

Changes to Pre-Existing Condition Insurance Plans aim to increase enrollment in high risk pools

Nov. 11, 2011

The Department of Health and Human Services has approved changes to increase enrollment in the Pre-Existing Condition Insurance Plan, the high-risk pool program established by the Affordable Care Act, including lowering members' premiums for the PCIP by 10 percent in Michigan.

Physicians Health Plan of Mid-Michigan has contracted directly with HHS to administer "Health Insurance Program for Michigan," the state's PCIP. Michigan's Office of Financial and Insurance Regulation has regulatory oversight of the program.

HIP Michigan provides health insurance coverage for Michigan residents of all ages who qualify for the program, and is available on a first-come, first-served basis, until funding runs out. HIP Michigan will not deny any applicant coverage or benefits because of health status. To ease eligibility, HIP Michigan will accept applications with certified provider documentation of a medical condition within the last 12 months.

The program ends Dec. 31, 2013, when similar coverage will be available through health insurance exchanges.

On Sept. 16, HHS approved Michigan's request to reduce monthly premiums by 10 percent and ease the process to document a pre-existing condition beginning Oct. 1.

To qualify for HIP Michigan, you must:

  • Be a resident of Michigan
  • Be a U.S. citizen or lawfully present in the United States
  • Have been denied coverage due to health conditions or been offered coverage with a rider excluding certain health conditions within the past six months or have a documented medical condition present within the last 12 months
  • Have been uninsured (not had credible coverage) for six months prior to submitting your application

Nation wide, PCIPs established by the ACA have 33,958 participants as of Aug. 31. There were 493 enrollees in HIP Michigan as of Aug. 31, and enrollment has gradually increased between May and September of this year. Michigan hopes to provide coverage for up to 3,500 residents for a limited time, based on the availability of federal funding.

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The information on this website is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. 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. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.