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State rolls out insurance for those with pre-existing conditions

Rochester Business Journal
August 30, 2010

New York has rolled out its version of a health insurance to cover individuals with pre-existing conditions, coming up with a relatively low-cost plan.

The New York Bridge Plan is open to applicants with verified pre-existing medical conditions who have been without health insurance for at least six months and are U.S. citizens and New York residents.

The new federal health care reform law requires each state to come up with a plan to provide coverage for people who have been turned down or dropped by commercial carriers because they are chronically ill or permanently injured or to let federal officials devise one. State Pre-Existing Condition Insurance Plans are slated to run until 2014, when insurance exchanges are supposed to be established.

In July, Gov. David Paterson said the state would shoot for PCIP rates of less than $600 a month.

The PCIP the state rolled out last week charges premiums of $362 a month to upstate residents and $421 a month in the 14 downstate counties. Office visit co-pays are $20; inpatient co-pays are $500. Specialist visits and prescription drugs are covered.  

The unusually low rates and relatively generous benefits are possible because PCIP premiums and the plans’ operational costs are federally subsidized, state insurance officials said. Once money allocated for the PCIP plan runs out, no new members would be enrolled. New York’s share of federal PCIP dollars is $297 million.

The New York PCIP is administered but not underwritten by Group Health Insurance Inc., a non-profit subsidiary of Emblem Health. The plan offers no family-coverage provisions. If more than one member of a household or family member has a pre-existing condition, each must take out a PCIP policy at the full rate. There are no income requirements or dollar restrictions on who can be covered.
Applications for New York Bridge Plan membership are available online at Coverage is slated to begin Oct. 1.           

(c) 2010 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or e-mail

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