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Pre-existing conditions covered by new high-risk insurance pools

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Beginning today, individuals with pre-existing health conditions are eligible to enroll in a temporary high-risk insurance pool, courtesy of the health care reform law. The new Pre-Existing Condition Insurance Plan is a provision of the Patient-Protection and Affordable Care Act (PPACA).

The new plan — administered by either a state or the Department of Health and Human Services — will provide health coverage options for individuals who have been uninsured for at least 6 months, have been denied coverage due to a pre-existing condition and are a U.S. citizen or legal resident. The program will be in effect until 2014 when insurers will no longer be able to deny coverage based on pre-existing medical conditions.

As of today, HHS will run the Pre-Existing Condition Insurance Plan in 21 states. The remaining 29 states and the District of Columbia will begin enrolling residents in their own insurance pools by the end of the summer, according to a press release from HHS.

From July 1, 2010, through Jan. 1, 2014, the law will provide $5 billion to fund the new plan in each state. Money will be allocated based on the population and costs of each state.

The plan, which is not based on income, will likely be an option for individuals with money to spend on insurance, but who have been denied coverage in the past due to a pre-existing medical condition such as cancer or diabetes. Although some states already have high-risk pools, by law, the new pools cannot charge higher premiums than the standard premiums in an individual’s given state.

Modeled after the Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan allows for flexibility by state as long as basic requirements are met. State programs may vary on cost, benefits and determination of pre-existing conditions. In addition, any unspent funding will be reallocated by the states. Unlike CHIP, however, there is no state matching requirement and the entire cost of the new plan will be covered by the federal government.

For more information on the federal high-risk pools, visit www.healthreform.gov.

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