Tuesday, March 18, 2014

Cliff, Kathy and PCIP

As we've remarked on numerous occasions, the PCIP (Pre-Existing Condition Insurance Plan) was actually a pretty great idea, and one of the very few pieces of the ObamaTax that was well-executed. And it's been scheduled to be executed for some time now: first, at the end of 2013, then the end of March, and now, well:

"Enrollees in the federally-run [PCIP], who have not yet found new health insurance coverage through the Marketplace, can purchase an additional month of PCIP coverage through April 30, 2014, while they continue their search."

That helpful news popped up on their site last Friday (the 14th), to little immediate fanfare. Now, of course, the news is all over the net, but as usual, we're only getting bits and pieces.

Because I have a client who is in the midst of this situation, and because we strive always to keep our readers better informed, I did some digging.

Here's the challenge: it is indeed true that the final day of the initial Open Enrollment "season" is March 31 [ed: unless DC wavers on that, as well]. Which is fine, but under the new rules, one must have one's application submitted at least two weeks prior to one's desired effective date. Since no one wants to work Saturdays, that also meant last Friday (again, the 14th) was the real cut-off date. So if you were on PCIP, and you knew for a fact that your coverage was ending March 31, you'd better have your ObamaApp in by last Friday.

Fortunately for my client, she did. Yes, it was a harrowing afternoon, but we got it done.

Imagine my surprise to walk in yesterday morning to find that - surprise! - the condemned had been given a one month reprieve.


After all, just because Ms Shecantbeserious has decreed it doesn't necessarily make it so (although one would think). So I called our broker rep for the carrier that actually issues (issued) the Ohio PCIPs, Medical Mutual; it was no surprise that they were also caught unaware, and had no idea how to answer any of my questions. I was directed to the Department of Insurance (of course).

So, called the DOI and was quickly routed to Chris, a supervisor who, no surprise, was also unaware of the details. It seems that just because it was decreed in DC, it doesn't mean that the troops in Columbus need to be informed. Since administration of Ohio's PCIP program was handed off to the Feds a while back, I would have to move higher up (or down, as applicable) the food chain, and my next call was to the folks at PCIP.gov, who were also very nice and eager to help.

Once I explained who I was and why I was calling, I asked how this was gong to work. Amanda told me that they would indeed be mailing out "coupons" (premium notices) and information...

By the end of the week.

Here's the thing: that means that at least a few of these will go out in Friday's mail, and will arrive in participants' mailboxes sometime during the last week of March, far too late to find other coverage, and barely enough time to meet the deadline for payment to be received (a very generous April 4th).

Now, they have the option of preemptively mailing in their April payment (which, thankfully, is the same as their March), making sure to note their billing number on their check.

Which may or may not arrive in time, either.

Oh, one more thing from the PCIP site's announcement:

"Enrollees will be notified by mail ... along with details about cost-sharing" [emphasis added]

Hunh? What does "cost sharing" even mean in this context? We use it in Medicare and in certain ACA plans, but PCIP?

Don't feel too bad: it also stumped Amanda. But she offered to find out for me, and I spent a scant few minutes on hold as she consulted a supervisor. The good news is that it's merely a case of someone being a bit too clever with their wording: it refers only to the co-insurance already built into the plan.


Now, maybe Cliff can get back to delivering those coupons.
blog comments powered by Disqus