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PCIP Coverage Ended April 30

Benefits coverage for enrollees in the federally-run Pre-Existing Condition Insurance Plan (PCIP) ended on April 30, 2014. PCIP benefits were not extended to May. This temporary program, created by the Affordable Care Act, was originally scheduled to end on December 31, 2013. We were able to extend benefits coverage to enrollees for an additional four months in 2014, to help ensure they did not experience a break in health coverage as they transitioned to other coverage through the Health Insurance Marketplace. Enrollees who did not have other coverage that began on May 1, 2014, are eligible for a 60-day special enrollment period that began on May 1, 2014, to enroll in new coverage through the Marketplace. They received a letter by mail that explains the steps to take. No matter when you enroll in other coverage through the Marketplace during the 60-day special enrollment period, your new coverage will still be effective back to May 1. This way, you avoid a break in your health coverage.

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Updated: Timely Filing of Claims & Appeals

Claims for PCIP must be received no later than 3 months from the date of service, and all claims must be filed by July 31, 2014. The benefits administrator will not accept claims after that date.

The timeframe for an enrollee to appeal a claims benefit determination is 2 months from the date of our decision.

Appeals for Eligibility and Reinstatement

All appeals must be filed by May 30, 2014. If we don’t receive your appeal by that date at the address below, you lose your right to appeal.

We encourage you to submit any documents that support your appeal. Make sure that your PCIP account number appears on your signed and dated letter and on any documents you send us. Please mail your appeal to the following address:

Office of Personnel Management
PCIP Appeals, Room 3468
1900 E Street, NW
Washington, DC 20415-3630

The Health Insurance Marketplace

The Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – finally have access to quality, affordable coverage. The next enrollment period for the Health Insurance Marketplace starts November 15, 2014, for the 2015 plan year.

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