Note: None of this should be taken as legal or tax advice.

In July, 2010, the health reform bill created the Pre-Existing Condition Exclusion Plan (PCIP) to provide health insurance coverage to uninsurable citizens. Currently, 24 states (including District of Columbia) administer their own PCIP program. The federal government and HHS run the program on behalf of the remaining states.

Eligibility for PCIP is based on the following criteria:

• Legal citizen of the United States
• Uninsured for 6-months prior to application
• Denied an individual health insurance plan due to a pre-existing condition

State	Federal or State Run?	State Program Name (if applicable)	Additional PCIP Notes*
Alabama	Federal	N/A
Alaska	State	ACHIA-FED	$1500 deductible plan, rates from $468/mo (25 yr old) to $1310/mo (55 yr old)
Arizona	Federal	N/A
Arkansas	State	CHIP
California	State	California PCIP	$1500 deductible plan, rates from $180/mo (25 yr old) to $564/mo (55 yr old)
Colorado	State	GettingUSCovered	$2500 deductible plan, rates from $184/mo (25 yr old) to $486/mo (55 yr old)
Connecticut	State	CT PCIP Plan	$1250 deductible plan, rates from $285/mo (25 yr old) to $628/mo (55 yr old)
Delaware	Federal	N/A
District of Columbia	Federal	N/A
Florida	Federal	N/A
Georgia	Federal	N/A
Hawaii	Federal	N/A
Idaho	Federal	N/A
Illinois	State	IPXP	$2000 deductible plan, rates from $135/mo (25 yr old) to $368/mo (55 yr old)
Indiana	Federal	N/A
Iowa	State	HIPIOWA-FED	$1000 deductible plan, rates from $261/mo (25 yr old) to $435/mo (55 yr old)
Kansas	State	PCIP-KS	$2500 deductible plan, rates available via phone at 1-877-505-0511
Kentucky	Federal	N/A
Louisiana	Federal	N/A
Maine	State	DirigoChoice	Choice of three deductible amounts from $1250 - $2500
Maryland	State	MHIP	$1500 deductible plan, rates from $141/mo (under 30) to $354/mo (65 and over)
Massachusetts	Federal	N/A
Michigan	State	HIP Michigan	$1000 deductible plan, rates from $241/mo (25 yr old) to $563/mo (55 yr old)
Minnesota	Federal	N/A
Mississippi	Federal	N/A
Missouri	State	MHIP	Choice of three deductible amounts from $1000 - $5000 with plan rates from $271/mo (25 yr old) to $570/mo (55 yr old)
Montana	State	MAC Plan	$2500 deductible plan, rates from $219/mo (25 yr old) to $516/mo (55 yr old)
Nebraska	Federal	N/A
Nevada	Federal	N/A
New Hampshire	State	NHHP-FED	$1000, $2000, and $2500 deductible plan options, rates from $159/mo (25 yr old) to $520/mo (55 yr old)
New Jersey	State	NJ Protect	Several plan options with plan rates from $252/mo (25 yr old) to $440/mo (55 yr old)
New Mexico	State	NMMIP	$500, $1000, and $2000 deductible plan options, rates from $168/mo (25 yr old) to $409/mo (55 yr old)
New York	State	NY Bridge Plan	Zero deductible plan with standardized premium rates ranging from $362/mo to $421/mo, depending on geographic location
North Carolina	State	Inclusive Health	Choice of four deductible amounts from $1000 - $4500 with plan rates from $109/mo (25 yr old) to $276/mo (55 yr old)
North Dakota	Federal	N/A
Ohio	State	Ohio Risk Pool	Choice of $1500 or $2500 deductible amounts with plan rates from $130/mo (25 yr old) to $358/mo (55 yr old), depending on geographic location
Oklahoma	State	OHRP	$2000 deductible plan, rates from $137/mo (25 yr old) to $395/mo (55 yr old)
Oregon	State	Oregon Medical Insurance Pool	Choice of four deductible amounts from $500 - $1500 with plan rates from $266/mo (25 yr old) to $557/mo (55 yr old)
Pennsylvania	State	PA Fair Care	$1000 deductible plan, with average rate of $283/mo
Rhode Island	State	PCIPRI	$1000 deductible plan, with plan rates from $231/mo (25 yr old) to $520/mo (55 yr old)
South Carolina	Federal	N/A
South Dakota	State	SD Federal Risk Pool	$2000 deductible plan, with plan rates from $231/mo (25 yr old) to $535/mo (55 yr old)
Tennessee	Federal	N/A
Texas	Federal	N/A
Utah	State	Federal HIPUtah	Choice of four deductible amounts from $500 - $5000 with plan rates from $137/mo (25 yr old) to $271/mo (55 yr old)
Vermont	Federal	N/A
Virginia	Federal	N/A
Washington	State	PCIP-WA	Choice of $500 or $2500 deductible amounts with plan rates from $221/mo (25 yr old) to $606/mo (55 yr old)
West Virginia	Federal	N/A
Wisconsin	State	HIRSP-Federal	Choice of four deductible amounts from $500 - $3500 with plan rates from $113/mo (25 yr old) to $340/mo (55 yr old)
Wyoming	Federal	N/A

  
SRC:  Pre-Existing Condition Insurance Plan Website

Note: None of this should be taken as legal or tax advice.

Guaranteed issue health insurance refers to health insurance that does not involve the process of medical underwriting and must be provided to an eligible applicant regardless of the applicant’s age, gender, or any pre-existing health condition prior to enrollment. In five U.S. states (MA, ME, NY, NJ, VT) medical underwriting is not allowed - that is, all individual market insurance companies must provide guaranteed issue individual health insurance plans. In the remaining states, where medical underwriting is allowed in the individual market, the availability of guaranteed issue health insurance varies by state.

Effective January 1st, 2006, federal law (HIPAA) requires all states to provide guaranteed individual health plans to residents who meet certain eligibility criteria. Individuals who meet this criteria are commonly referred to as "HIPAA-eligible" (or "federally HIPAA-eligible") individuals. If an individual meets the federal definition of "HIPAA-eligible", then the state must provide that individual with guaranteed issue individual health insurance. Typically, states provide these plans through a state risk pool. However, some states transfer this responsibility to private insurance companies.
Most states go far beyond this federal mandate and offer guaranteed issue individual health insurance plans to all of their uninsurable residents.

None of this should be taken as tax or legal advice.

Note:  None of this should be taken as legal or tax advice.

Key Stat:  One out of every two small businesses does not offer health insurance to their employees.  Most employees of these companies pay 30-50% more than they need to for their individual health insurance policy because they pay their premium with post-tax dollars.

Yesterday, I wrote about Section 125 Premium-only-Plans (POP).  These plans allow employees to pay for their health insurance premiums tax-free. Traditionally, employers with group insurance plans offer a POP plan so that an employee can pay his or her portion of the group premium with tax-free dollars.  However, recent changes to federal law now allow employees to utilize Section 125 POPs to pay for their individual insurance premiums tax-free.  Subsequently, some states (e.g. Minnesota) are beginning to pass state laws mandating that employers offer Section 125 POP (for individual policies) to their employees. 


Beginning January 1, 2009, employees can use Section 125 POP plans to pay for their individual insurance premiums tax-free.  Under IRC Section 1.125-1(m), employees are able to purchase individual health insurance policies with tax-free dollars.  This law-change presents a huge tax-savings opportunity for small businesses and their employees.  Now employees do not pay federal or state income tax on the amounts used to pay insurance premiums and the employee and employer do not pay FICA or FUTA (i.e. Medicare, Social Security, or unemployment insurance taxes) on these amounts.  The result is a reduction in the the cost of individual insurance policies by 30-50% depending on the tax-bracket.


Beginning July 1, 2009, a new Minnesota law requires that certain small employers offer Section 125 POP plans for individual policies.   Under Minnesota SF 3780, employers who have more than ten (10) full-time employees and who do not currently offer health benefits must establish and maintain a Section 125 plan to allow their employees to purchase individual health coverage with pre-tax dollars.  Remember, with Section 125 POP, employers do not pay FICA or FUTA (~7.65%) on any money an employee uses for their individual insurance payments.  Thus, employers can expect to save nearly eight cents ($0.08) for every dollar ($1.00) their employees spend on individual health insurance.

At Zane Benefits, we are finalizing a web-based POP administrative platform ("ZanePOP") for employers of all sizes.  ZanePOP's expected release date is 10/01/2009.  You can view details on our new solution here.  Please let us know what you think!