New Options for the Uninsurable
If you’ve been prevented from getting health insurance because of a pre-existing medical condition, this news will help you feel better.
It’s called the Pre-Existing Condition Insurance Plan (PCIP)
As you might guess from the name, the PCIP offers health coverage to medically uninsurable individuals in California. Details can be found at the PCIP website: pcip.ca.gov
The program is for individuals who have not had health coverage in the last 6 months and is run by the Managed Risk Medical Insurance Board (MRMIB).
A High-Risk Pool for Those With Pre-Existing Conditions
Following the federal Affordable Care Act of 2010, California has contracted with the federal Department of Health and Human Services to set up a federally funded high-risk pool program to provide health coverage for people with pre-existing conditions. The program will last until December 31, 2013 (when national health reform is set to begin).
The high-risk pools will go away by 2014 because new federal rules will not allow insurers to reject people for pre-existing conditions, nor charge them higher rates.
How to Qualify for PCIP
To be eligible, you must meet five requirements:
- Be a California resident.
- Have no health insurance coverage for the past 6 months. (This means you were not enrolled in an individual or job-based health plan, including COBRA or Cal-COBRA, or Medicare Part A and/or Part B, or in Medicaid/Medi-Cal.)
- Be a U.S. Citizen, U.S. National, or otherwise be in the U.S. lawfully.
- U.S. Citizens or U.S. Nationals must provide their Social Security Number.
- Have been denied individual insurance coverage within the past 12 months for a pre-existing condition, shown by:
- A denial letter from a health insurance company or health plan (dated within the last 12 months) or
- An offer of individual (not group) health coverage with higher premiums than the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) rate in your area (dated within the last 12 months) or,
- Letter from a licensed doctor, physician assistant, or nurse practitioner dated within the past 12 months, stating that the individual has, or had at any time in the past, a medical condition, disability, or illness.
Who Can Apply for PCIP?
- Anyone 18 or older. You must apply for coverage for your own coverage;
- Parents (natural or adoptive) or stepparents applying for children under 18 years old. (You cannot apply for children 18 years of age or older.)
- Legal guardians, foster parents, or caretaker relatives applying for a child under 18 living at home;
- An emancipated minor. (Under age 18 who does not live with parents, legal guardians, stepparents, or caretaker relatives.) Emancipated minors must apply for themselves.
Call PCIP at 1-877-428-5060, Monday through Friday, 8 a.m. to 8 p.m., or Saturday 8 a.m. to 5 p.m. Or call us at Archer Weiss, toll-free at (800) 831-2901 and we’ll be happy to fill you in.