California Pre-Existing Condition Insurance Plan (PCIP) Offers Health Insurance to Residents in High Risk Pools through 2013

/

As a result of the federal healthcare reform legislation signed in 2010, the State of California established a federally-funded high risk pool program to provide health coverage for eligible individuals. The program will last until December 31, 2013, when national health reform is set to begin. After that date, there will no longer be a need for high risk pools because federal rules will not allow insurers to reject persons with pre-existing conditions or charge them higher rates than those without such conditions.

This federally-funded program is called the California Pre-Existing Condition Insurance Plan (PCIP). The PCIP offers health coverage to medically-uninsurable individuals who live in California. PCIP is available for individuals with pre-existing medical conditions who have not had health coverage in the last 6 months. The California PCIP is run by the Managed Risk Medical Insurance Board (MRMIB).

Here are some additional tidbits about California PCIP:

  • It is available only to individuals with pre-existing conditions. Dependents must qualify separately for PCIP or obtain coverage through other means.
  • You must be a U.S. Citizen, U.S. National or lawfully present in the U.S.
  • PCIP premiums in Ventura County range from only $107/month for under 15 years of age to a maximum of $481/month for ages 60+. (Premiums vary by age and county.)
  • The plan has a provider network of 11,000 primary care physicians 43,300 specialists.
  • Annual deductible is $1,500/$3,000 for in/out-of-network providers, with a $2,500 maximum for in-network and no annual/lifetime benefit caps. Wow!

If you are in a precarious medical situation, unemployed and not covered by insurance, the California PCIP is an outstanding way to obtain the coverage you need at a very reasonable cost.

The state also has another plan called the Major Risk Medical Insurance Program (MRMIP) that is available to individuals with pre-existing conditions that do not qualify for PCIP. MRMIP is more similar to COBRA insurance through an ex-employer's plan in that it is available to both the subscriber and his/her dependents. MRMIP is geared towards people in need of insurance who have had health insurance in the last 6 months. The rates are much higher and the maximum benefits much lower than the PCIP to the point where I would recommend it only as an alternative to COBRA.

For detailed information about PCIP and to enroll, visit www.pcip.ca.gov or call 877.428.5060.