Effective March 2, 2013, the federal government is suspending new enrollment in the NY Bridge Plan and all state-run PCIPs throughout the country, with the exception of previously enrolled PCIP members who move from one state to another. These individuals will be allowed to submit an enrollment application in their new state. Previously enrolled PCIP members can obtain a NY Bridge Plan enrollment application by calling 1-877-444-9622.
Frequently Asked Questions
What is the Pre-Existing Condition Insurance Plan?
The federal health reform law (the Affordable Care Act) created a temporary program that makes affordable health insurance available for individuals who:
- Are citizens or legal US residents.
- Reside in New York State.
- Have one or more pre-existing medical conditions.
- Have not had health care coverage for the last six months.
This program, called the Pre-Existing Condition Insurance Plan (PCIP), is available throughout the country. The program will remain in effect until 2014.
What is New York State’s PCIP?
New York State’s PCIP is called the New York Bridge Plan. New York State chose GHI, an EmblemHealth company, to administer its PCIP.
- What type of coverage does the NY Bridge Plan offer?
The NY Bridge Plan covers a broad range of services, including primary and specialty care, inpatient and outpatient hospital care, and prescription drugs. It also provides assistance from professional nurses and caseworkers to help you manage a chronic condition and maintain overall health. The NY Bridge plan features:
- No deductibles
- $20 office visit copays
- $100 emergency room copays
- $500 inpatient hospitalization copays
- Pharmacy benefits
- Vision care
- Preventive care
The NY Bridge Plan is an Exclusive Provider Option (EPO), which means that you must use doctors and health care providers who are in the GHI EPO network, except in cases of emergency or when care is not available through a participating provider.
- Which pre-existing conditions qualify an applicant for coverage in the NY Bridge Plan?
These pre-existing medical conditions qualify for coverage in the NY Bridge Plan. Other pre-existing conditions not listed will be subject to medical review. Applicants will be required to submit medical records for consideration.
- What documents must I submit to prove that I have a pre-existing condition?
With your NY Bridge Plan application, you will be asked to provide one of the following as proof of at least one qualifying pre-existing medical condition:
- A letter from a health care provider that specifies you have one of the qualifying medical conditions.
- Your current medical records specifying that you have one of the qualifying medical conditions.
- A copy of your online personal health record indicating you have one of the qualifying medical conditions.
- Is there an annual recertification for the NY Bridge Plan?
- Are there any exceptions to the requirement that applicants be uninsured for at least the last six months?
Yes, newborns with serious or qualifying medical conditions may enroll if they meet the eligibility requirements, with the exception of having no insurance for the previous six months.
- Do individuals have to be residents of New York State to enroll in the NY Bridge Plan?
Yes, you must be a resident of New York State to qualify for coverage through the NY Bridge Plan. If you live in another state, you may apply for coverage in that state's plan. An individual who was enrolled in another state's PCIP and moves to New York will be able to apply for the NY Bridge Plan without having to wait six months or re-qualify. Applicants who transfer from another state’s PCIP have up to 6 months to enroll in the NY Bridge Plan.
- Is there an age limit to enroll in the NY Bridge Plan?
Once you turn 65 years of age and enroll in the Medicare program, you will no longer be eligible for the PCIP. There is no minimum age to qualify — even newborns may be enrolled if they meet the eligibility requirements.
- Is coverage for dependents available from the NY Bridge Plan?
No, this is individual coverage. In order to qualify, each person must meet the eligibility requirements set by the federal government. If other family members qualify for the NY Bridge Plan, they may apply separately. Family coverage is also not available through the NY Bridge Plan. Family members must qualify individually.
- When will my NY Bridge Plan coverage begin?
Eligible applicants will be notified in the order that their applications are received. For completed applications received and approved by the 15th of the month, coverage will be effective the first day of the next month. For those received after the 15th, coverage will be effective the first day of the month after the following month. For example, for applications approved by October 15, coverage will be effective November 1. For applications approved after October 15, coverage will be effective December 1.
The NY Bridge Plan, and each state's PCIP, ends on January 1, 2014, when the state-based health benefit exchanges are established and other insurance market reforms go into effect, providing new coverage options for people with pre-existing health conditions.
- How do I find out if my doctor is in the NY Bridge Plan’s network of providers?
The NY Bridge Plan will utilize the same network as GHI's other Exclusive Provider Option (EPO) plans, with additional network providers available in upstate New York counties. To find a doctor, search the directory by selecting “NY Bridge Plan,” which is the second option under Plan (see example below).
- How much does NY Bridge Plan coverage cost?
Premium rates for the NY Bridge Plan are set depending upon where the member lives.
- For those who live in downstate New York, the premium rate is $421 per month.
- For those who live in upstate New York, the premium rate is $362 per month.
Premium bills are sent to you directly.
- What happens when the program ends in 2014?
When the PCIP terminates on January 1, 2014, other provisions of health reform will go into effect, and state health benefit exchanges will be available for individuals to purchase coverage. At that time, premium and cost-sharing subsidies will be available for individuals with incomes between $14,404 and $57,616 and for families of four with incomes between $29,327 and $88,200. People will also be able to choose to purchase coverage in the individual market.