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Pre-Existing Condition Coverage in New York

If you live in New York and have a pre-existing condition, you may be eligible to participate in the New York Pre-Existing Condition Insurance Plan (PCIP), also known as the NY Bridge Plan.

What is the New York Bridge Plan?

With the passage of the Patient Protection and Affordable Care Act in March of 2010, New York was able to provide a temporary program for uninsured individuals with pre-existing conditions. The program, administered by Group Health Incorporated (GHI), is a stop gap until other provisions in the health-care reform go into effect in 2014. Since it is a stop gap, after 2014 the NY Bridge Plan will no longer be available.

Qualification and Enrollment

In order to enroll you must be a legal US resident and a permanent New York resident. You must also have one or more pre-existing conditions  and have been without health insurance for the past six months.

You have the option of applying online or downloading the plan application.  If you download the application, complete it and mail it to NY Bridge Plan, PO Box 5008, New York, NY 10274-5008. If you have any questions when completing the application, call the Bridge plan at 1-866-693-9277 and speak to one of their specialists.

Once it is received and reviewed, you will be notified if your application is approved. If it is approved by the 15th of the month or earlier, your coverage goes into effect on the first of the following month. If you are approved after the 15th of the month, your coverage begins on the first of the second month after approval. For example, approval on January 13th means coverage goes into effect on February 1st. If approved on January 16th coverage goes into effect on March 1st.

Bridge Plan Premiums

The NY Bridge Plan is not a health insurance plan for low income individuals and is not underwritten based on income. Enrollment is on a first-come first-served basis (if the enrollment is filled to capacity, you will be put on the waiting list) and the premium is determined based on your home county location. If your county is located in lower New York State, the premium is $421 per month. For upstate residents, the premium is $362 per month.

The dividing line between upstate and down state is located midway through the Hudson Valley. Dutchess, Ulster, Orange, Putnam counties and lower are considered downstate. Greene, Columbia, Albany, Rensselaer and north are considered upstate.

NY Bridge Plan

There are no family discounts with the Bridge plan. If two or more individuals in a particular family qualify for the plan, they will have to purchase to separate policies and will be billed accordingly.

Bridge Plan Benefits

There are no deductibles and low co payments. Coverage for doctor office visits and Chiropractic care have a $20 per visit co payment while conditions such as maternity pre and post natal care are fully covered. The plan provides preventive care, pharmacy benefits and vision care. Download the NY Bridge Plan Benefits document for more details regarding coverage and co-payments.

If you are interested in the NY Bridge plan, complete and submit your application as soon as possible since it’s on a first come first serve basis and spaces are limited.

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