The NY Bridge Plan, New York State's Pre-Existing Condition Plan (PCIP) will stop taking new applications after March 2, 2013. The federal government is suspending new enrollment in all state-run PCIPs throughout the country. The NY Bridge Plan website has this announcement:
"In accordance with the federal government mandate, the NY Bridge Plan cannot process new enrollment applications that are received after March 2, 2013.
The one exception to this mandate is for individuals who were already enrolled in a PCIP in another state but then changed their residence and moved to New York State. Individuals who were enrolled in a PCIP in another state will be allowed to enroll in the NY Bridge Plan after March 2, 2013. Enrollment applications for previously enrolled PCIP members can be obtained by calling 1-877-444-9622.
Individuals who are currently enrolled in the NY Bridge Plan will continue to receive health coverage until the end of 2013. Beginning October 1, 2013, individuals will be able to apply for affordable health insurance coverage in the Health Insurance Marketplaces (the “Exchanges”) ...
PCIPs, including the NY Bridge Plan, have been partially funded by the federal government and subject to federal regulations established under the Patient Protection and Affordable Care Act. GHI administers the PCIP (NY Bridge Plan) in this state. PCIP is the insurance pool for uninsured high risk individuals, who are people with pre-existing medical conditions that are expensive to treat. It has been providing coverage since October 1, 2010.
Here is a link to a Q&A about the program,
http://www.ghi.com/nybridgeplan/faq.html with the text pasted in this article. The home page is www.nybridgeplan.com. A brochure and application can be downloaded here. Enrollment is first come/first served.
For more information about national health reform and implementation in New York State, see this article.
NY Bridge Plan
Frequently Asked Questions
In March 2010, Congress passed the health reform law, the Patient Protection and Affordable Care Act (PPACA). The law created a temporary program until January 2014 that makes coverage available for individuals who:
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Are legal US residents.
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Reside in New York State.
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Have one or more pre-existing medical conditions.
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Have not had health care coverage for the last six months.
This new program is called the Pre-Existing Condition Insurance Plan (PCIP), and will be available throughout the country.
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What is the NY Bridge Plan?
New York State chose GHI, an EmblemHealth company, to administer its PCIP. It is called the NY Bridge Plan, 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.
The NY Bridge Plan will cover a broad range of services, including primary and specialty care, inpatient and outpatient hospital care, and prescription drugs, as well as assistance from professional nurses and caseworkers to help you manage a chronic condition and maintain overall health. The NY Bridge plan will feature:
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No deductibles
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$20 office visit copays
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$100 emergency room copays
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$500 inpatient hospitalization copays
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Pharmacy benefits
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Vision care
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Preventive care
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How do I enroll?
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Complete an application.
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Send the required documentation for pre-existing conditions and citizenship.
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You will receive a letter from the NY Bridge Plan indicating the status of your application.
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If you are determined to be eligible, you will receive an acceptance letter.
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Shortly after, you will receive a bill for your premium.
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Once your premium is received, you will have coverage.
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You will receive you ID card and welcome kit.
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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.
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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:
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Letter from a health care provider that specifies you have one of the qualifying medical conditions.
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Current medical record that specifies you have one of the qualifying medical conditions.
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Copy of online personal health record indicating you have one of the qualifying medical conditions.
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How do I remain eligible for the NY Bridge Plan?
As long as you do not become eligible for an employer based plan or similar comprehensive health benefit plan and meet the other eligibility requirements that originally allowed you to qualify, you may maintain eligibility for the NY Bridge Plan.
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Are there any exceptions to "being 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.
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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 requalify. Applicants who transfer from PCIPs in other states have 63 days to enroll in the NY Bridge Plan.
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Is there an age limit to enroll in the NY Bridge Plan?
Once you turn 65 years of age and qualify for Medicare, 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.
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Can enrollees include dependents in the NY Bridge Plan?
No, this is individual coverage and 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.
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When does the NY Bridge Plan go into effect? How can I enroll?
The NY Bridge Plan began accepting applications on August 20, 2010. The first effective date for coverage will be October 1, 2010. Your premium payment must be received by GHI for your coverage to 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. If the NY Bridge Plan reaches capacity, a waiting list will be established.
The NY Bridge Plan, and each state's PCIP, will terminate 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.
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How much will NY Bridge Plan coverage cost?
Premium rates for the NY Bridge Plan are set depending upon where the member lives.
Premium bills are sent directly to the subscriber.
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Is family coverage available?
No. Each member of the family must qualify as an individual. Therefore, there is no family coverage for this program.
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Given that this is a temporary form of coverage, what happens to people when the PCIP terminates 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.
[NOTE: due to funding limitations, the federal government has directed states to "shut down" their PCIPs to new applicants before January 2014. New York will stop taking new applications after March 2, 2013.]
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Is my doctor in the network of the NY Bridge Plan?
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).
