FAQ: PA Fair Care

Is my health insurance coverage ending?

PA Fair Care is Pennsylvania’s Pre-existing Condition Insurance Plan (PCIP), which was established as a temporary health insurance program until the federal health insurance exchanges are available.


Your health insurance coverage will be transitioned to the federal Pre-existing Condition Insurance Plan (PCIP) on July 1, 2013, and will now be administered by the federal PCIP program.  All PCIP coverage, including the federally-run PCIP program, is slated to end Dec. 31, 2013.


Why is this happening now?  

All PCIPs, including PA Fair Care, began as federal programs within the federal Centers for Medicare and Medicaid Services (CMS). CMS has decided that they can no longer provide the funding which had been committed at the state level.  Regrettably, we have been directed by CMS to cease administering the program, and transition all enrollees to the federal PCIP.


When does the PA Fair Care transition to the federal administrator take place?

The transition is under way now. CMS anticipates that a premium notice, a new enrollee handbook and identification card will be in your mail this month. This new card and network will be effective July 1, 2013.  It’s important to watch your mail closely for this information. It will not be identified as PA Fair Care, but will come from the federally-run PCIP program, likely via the National Finance Center.  It is our understanding that the National Finance Center (NFC), a Federal agency based in Louisiana, will handle enrollment and premium billing and collection.    


Will I need to complete a new application?

No. However, you do need to pay your monthly premium before your health insurance coverage with the federally-run PCIP can be activated.  You will not have health insurance coverage if you do not pay your premium to the federal PCIP program.


Will my monthly premiums or out-of-pocket expenses increase?

It is possible they may increase.  The federal PCIP program is rated differently from PA Fair Care. Age is the determining factor for premium under the federally-run PCIP program. 


Does the deductible calculation begin anew as of July 1? 

CMS has indicated your deductible will begin again; however, deductibles will be prorated. This means that your new deductible will be half of what a full-year deductible would be in the federal PCIP program.


Will my provider be part of this PCIP provider network? 

If your provider accepts Medicare rates, the federal PCIP program will accept your provider.


If my provider is not included in the new network, what are my options? 

The federal PCIP program will provide you with a list of participating providers that will accept your coverage.


Is there a continuity of care plan if I am in the middle of treatment?

Yes. You will be mailed information about how to transition your care.  Pre-authorizations already issued for treatment after June 30, 2013, will need to be revisited and reissued under the federally-run PCIP program.


Where do I go for more information?

You should watch your mail, especially during the month of June, for more information.  Mail will come from the National Finance Center (NFC) and should include a program website, plan materials and a national toll-free call center telephone number. NFC will be able to receive calls in early June. Currently, that number is listed as 866-717-5826.