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CCH® BENEFITS — 07/12/10

Health Reform’s Temporary High Risk Program Begins Operation

On July 1, Kathleen Sebelius, Secretary of Health and Human Services (HHS) announced the implementation of “a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.”

The PCIP implements Sec. 1011 of the Patient Protection and Affordable Care Act, which established a temporary high risk insurance pool program for individuals who have been uninsured for six months or who have been denied a policy because they have preexisting conditions.

The funding for this high risk pool program is capped at $5 billion. The program is set to end on Jan. 1, 2014.

HHS provided states with the option of running a PCIP themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.

Starting on July 1, the national PCIP opened up to applicants in these 21 states where HHS is operating the program: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, and Wyoming.

The remaining 29 states, which are operating their own PCIP, will begin enrollment by the end of the summer, with many beginning enrollment today.

In order to facilitate enrollment in a PCIP, HHS on July 1 set up a consumer Web site, http://www.HealthCare.gov. Individuals who live in a state where the HHS is running the PCIP will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply.

PCIP System Of Records

On July 2, HHS’s Office of Consumer Information and Insurance Oversight (OCIIO) also issued a notice in the Federal Register proposing a new system of records titled Pre-Existing Condition Insurance Plan (PCIP), System No. 09-90-0275. Such a system of record is required by the Privacy Act of 1974.

Where HHS contracts with a State to administer the temporary high risk program, HHS will make available a PCIP under arrangements with the U.S. Office of Personnel Management, the U.S. Department of Agriculture’s National Finance Center (NFC), and one or more nonprofit entities to serve as a third-party administrator (TPA) responsible for maintaining a network of health care providers and adjudicating claims for covered services.

The purpose of the PCIP system of records is to collect and maintain information on individuals who apply for enrollment in the temporary high risk program. This information will enable HHS acting through NFC, OPM, and any third-party administrator(s) to determine applicants’ eligibility, enroll eligible individuals into the program, adjudicate appeals of eligibility and coverage determinations, bill and collect premium payments, and process and pay claims for covered health care items and services furnished to eligible individuals.

For more information on this notice, contact OCIIO’s Jill Gotts ((202) 690-5894 or jill.gotts@cms.hhs.gov).

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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