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As a result of the federal Affordable Care Act of 2010, California has a contract with the federal Department of Health and Human Services to establish a federally-funded high risk pool program to provide health coverage for eligible individuals. The program will last until December 31, 2013 when the 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.
The 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. The program is available for individuals who have not had health coverage in the 6 months prior to applying. The California PCIP is run by the Managed Risk Medical Insurance Board (MRMIB).
Pre-Existing Condition Insurance Plan Questions and Answers
Q. If I currently have insurance that is very expensive, can I switch to this new program?
A. No. Unfortunately, federal law prohibits anyone with insurance or who has had insurance within six months of application from eligibility for PCIP.
Q. What if I disenroll in my current health plan and wait for six months to seek PCIP coverage?
A. The state of California cannot advise you on this decision.
Q. How do the premiums compare to MRMIP?
A. PCIP premiums are more than 40 percent cheaper than the cost of coverage provided by the state’s high-risk pool for persons with pre-existing conditions: the Major Risk Medical Insurance Program (MRMIP). For example, for a 50-year-old resident of San Francisco, coverage through PCIP would cost $499 monthly; for the corresponding plan under MRMIP, the monthly cost would be $915.
Q. What is the difference between the benefits of PCIP and MRMIP?
A. Both plans offer broad coverage; however, PCIP does not have any annual or lifetime limits while MRMIP caps coverage at $75,000 annually and $750,000 for lifetime.
Q. Exactly what does PCIP cover?
A. PCIP covers inpatient and outpatient care provided by doctors, psychologists, hospitals, laboratories and imaging centers; the plan also offers generic and brand-name drugs purchased through mail order or a large pharmacy network; disease management services; 24-hour nurse advice and online services.
Q. The federal government is providing the state of California with $761 million to pay for PCIP. Why do I have to pay premiums too?
A. The federal allocation pays for approximately 65 percent of the cost of coverage and the individual is expected to pay for 35 percent of the coverage. This offers a person with pre- existing conditions coverage at a cost no more than what a person without pre-existing conditions would pay in the open-market.
Q. How can I get more information on PCIP?
A. Visit the program website at www.pcip.ca.gov or call 1-877-428-5060 begin_of_the_skype_highlighting 1-877-428-5060 end_of_the_skype_highlighting.
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