North Carolina Pre-Existing Condition Insurance Plan (PCIP) 
Do you have a pre-existing conditionPATIENT FAQ 

The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition.  This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people if they have had a problem getting health insurance due to a pre-existing condition. 

How do I know if I am eligible for coverage through PCIP?*

Eligible individuals must:

  1. Be a U.S. citizen or a legal resident
  2. Have a pre-existing medical condition
  3. Not have been covered under health coverage for the previous six months before applying for coverage (proof of denial from insurance company will be needed)

How do I enroll for the Pre-Existing Condition Insurance Plan?

How much does the Pre-Existing Coverage Insurance Plan cost me?**

$183 to $729 per month depending on age, plan type, and smoker vs. non-smoker.

What benefits do I receive under PCIP?

Covered In-Network Services:

  • $1,000 - $4,500 annual deductible (except for preventive services) depending on plan type.
  • Patient pays 20% of the cost of covered benefits
  • Out-of-pocket costs capped at $5,950 per year
  • No lifetime maximum
  • Preventive services include: periodic health evaluations (ie. annual physicals), screening services (ie. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.

*Persons currently covered by a health plan, including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for the Pre-Existing Coverage Insurance Plan. PCIP coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.

**Premiums may be subject to changes made by PCIP.