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Many people who have been unable to get health insurance can now get coverage and have their pre-existing conditions covered, at an affordable premium, under the Affordable Care Act.

To be eligible for the Pre-Existing Condition Health Plan (PCIP), you must be a citizen or national of the United States or reside in the U.S. legally, have been uninsured for at least the last six months, and have a pre-existing condition or have been denied coverage because of your health condition.

Network Benefits Summary:

Standard Option Extended Option

----------------------------- ------------------------------

Benefit Maximum Unlimited Unlimited

Deductible/year $2,000 $1,000

Pre-Existing Conditions Covered Immediately Covered Immediately

Coinsurance 80% 80%

Out of Pocket Maximum* $4000,then 100% cvg $4000,then 100% cvg

Hospital & Surgery 80% 80%

Office Visits $25 Copay/100% $25 Copay/100%

Preventive Care 100%, no Copay 100%, no Copay

Emergency Room 80% 80%

Lab & Xray 80% 80%

Maternity/Newborn 80% 80%

Therapy 80% 80%

Mental Health 80% 80%

Prescription Rx(form) $500 deductible $250 deductible

Generic, 1st 2 fills: $ 4 Copay $ 4 Copay

3rd fill & after: $ 4 or 50% $ 4 or 50%

Brand Name, 1st 2 fills: $40 Copay $30 Copay

3rd fill & after: $40 or 50% $30 or 50%

Mail order (90 day supply)

Generic: $ 10 Copay $10 Copay

Brand: $100 Copay $75 Copay

*Includes deductible & copays

Guaranteed acceptance

individual health insurance

Do you need health insurance but have a pre-existing condition?

Standard Extended

Plan Plan

---------------- ----------------

Age 0-18 $ 139 $ 187

Age 19-34 $ 208 $ 280

Age 35-44 $ 250 $ 336

Age 45-54 $ 319 $ 429

Age 55-64 $ 443 $ 596

Age 0-18 $ 118 $ 158

Age 19-34 $ 176 $ 237

Age 35-44 $ 211 $ 284

Age 45-54 $ 270 $ 363

Age 55-64 $ 376 $ 505

Age 0-18 $ 147 $ 198

Age 19-34 $ 220 $ 296

Age 35-44 $ 264 $ 356

Age 45-54 $ 338 $ 455

Age 55-64 $ 470 $ 633

Other states: Call 800-527-1397 for quote.

Monthly Premium (male or female):

Florida

Georgia

South Carolina

U.S. Department of Health and Human Services

Provided by the:

Name:

Address:

City, State, Zip

Phone

Email Address

Have you been insured in the last six months?

Have you been declined for health insurance?

Do you have a Pre-Existing Condition?

Preferred method of contact?

COMMENTS:

To learn more about the Pre-Existing Condition Health Plan, and for assistance in determining your eligibility and application, please complete the form below and click the <SUBMIT> button.

There is no cost for our service.

Questions? Call 800-527-1397

The federal Pre-Existing Condition Health Plan may or may not be right for you.

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We will be in touch with you by phone or email.