Applying Online for the Pre-Existing Condition Insurance Plan (PCIP)

Uploaded by CMSHHSgov on 22.05.2012

If you have a pre-existing condition, and do not currently
have health coverage, the Pre-Existing Condition Insurance
Plan may be the right option for you.
You must live in one of the GREEN states to apply online at If you do not, click on the Find Your State tab
here on the PCIP website.
This Plan provides comprehensive health benefits, such as
physician visits, hospital care, and prescription drugs.
And, you're not charged more because of your health.
You are eligible for PCIP if you: - are a U.S. citizen or
reside here legally; - have been WITHOUT health coverage for
at least 6 months; and - have a pre-existing condition.
If you're eligible, you'll need to fill out an application.
Here's what you can expect when applying online at
After reading these helpful tips, click on Apply Now.
Tell us where you live. If you do not see your state in the
dropdown menu, please click on this link to find out how to
apply in your state.
You'll provide basic information here. Please fill in all
the fields.
Here you'll select your citizenship or immigration status.
Click on this icon to see what documentation you may be
required to submit.
Tell us about other health insurance coverage you may have
had in the past 6 months. If you've had any of these types
of coverage, even if it excluded your pre-existing
condition, you are NOT eligible for PCIP.
Please answer all of the Yes/No questions so we can verify
recent health coverage you may have had. You are still
eligible for PCIP if you've had one of these types of
coverage in the past 6 months: coverage only for an accident
(including accidental death and dismemberment); liability
insurance; workers compensation; and fixed indemnity
We need to know that you have a pre-existing condition.
Select one of these documents to use as proof of your
You can provide a copy of a denial letter from an insurance
company licensed in your state that says you are not
eligible for individual coverage. Insurance through your
employer doesn't count. The letter could also come from a
licensed agent or broker.
In this case, you would provide a copy of an offer of
individual coverage with a rider that you did NOT accept.
The rider excludes coverage for your pre-existing condition.
You are NOT eligible for PCIP if you accept this insurance
coverage, even if it has a rider.
If you are under age 19 or a resident of Massachusetts or
Vermont, you can provide a letter from a doctor, a physician
assistant, or a nurse practitioner that states your current
or past medical condition, disability, or illness.
This option is available to an individual under age 19 OR
someone who lives in Massachusetts or Vermont. You can
provide a copy of an offer for individual insurance coverage
from an insurance company that you did NOT accept, with a
monthly premium at least twice that of the Standard Option
in your state.
To find out what the Standard Option premium is in your
state, go to and click on "Find Your State."
Here, tell us if you currently have or had health coverage
within the past year.
If you've had coverage recently, there's space here to
include information about it and why the coverage ended.
Here, you can view or download a copy of your application
and save it for your records.
In this section, you will select one of the three plan
options to apply for.
You can also choose to have your premium payments
electronically transferred from your bank account.
You're almost finished when you get to this screen. Please
read each statement and check each box.
On the Signature screen, you'll provide the last few pieces
of information. Then click on the FINISH button to get your
Be sure to include the "e-form" number on each document you
may be required to mail in.
That's how the online application works. If you need more
help completing yours, you can contact us for help at
TTY users should call 1-866-561-1604.