This is Part II of the article written by Dr. Viggiani
The Pre-existing Condition Insurance Plan (PCIP) provides access to insurance for people with pre-existing conditions who have been denied coverage and meet other eligibility criteria (Figure); more information on this plan can be found on the PCIP Website.[5] Recent updates to this benefit have reduced premiums by as much as 40% and eased eligibility standards.[6]
Providing Consumer Protections
The ACA has a number of provisions in place to protect consumers. Health plans that began on or after September 23, 2010 can no longer retroactively cancel insurance coverage solely because the patient or employer made an honest mistake on their insurance application.[7]
All job-related health plans that cover children and individual health insurance policies issued after March 23, 2010 cannot limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a “pre-existing condition.”[8]
Lifetime limits on most benefits are prohibited in any health plan or policy issued or renewed on or after September 23, 2010, and the ACA also restricts and phases out the annual dollar limits many health plans can place on most covered benefits.[9]
As patients look to healthcare providers for guidance on how the ACA will benefit them, it is important for clinicians to have a clear understanding of the new law and its provisions.
For more information on these and other provisions of the ACA, visit HealthCare.gov.
