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Access for Uninsured Americans with Pre-Existing Conditions

Note: Following federal direction, received on February 15, 2013 California PCIP will suspend new enrollments for applications received after March 2, 2013.

Applications received after March 2, 2013, will be screened for eligibility for the Major Risk Medical Insurance Plan (MRMIP). MRMIP, the state high risk pool is still open for new enrollment and available for individuals with a pre-existing condition. The application is for both programs.  For more information, click here.

Access for Uninsured Americans with Pre-Existing Conditions

The Pre-Existing Condition Insurance Plan (PCIP) makes health coverage available to you if you are a U.S. citizen or reside here legally, have been denied health insurance because of a pre-existing condition, and been uninsured for at least six months.

What It Means To You:

The Pre-Existing Condition Insurance Plan (PCIP) makes health coverage available to you if you are a U.S. citizen or reside here legally, have been denied health insurance because of a pre-existing condition, and been uninsured for at least six months. Eligible residents of California can apply for coverage through the state’s Pre-Existing Condition Insurance Plan program run by the Managed Risk Medical Insurance Board.

To qualify for coverage

  • You must be a citizen or national of the United States or lawfully present in the United States.
  • You must have been uninsured for at least the last six months before you apply.
  • You must have a pre-existing condition, have been denied individual health insurance coverage within the past 12 months, or have been offered individual health insurance coverage at a premium rates higher than the California Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) within the last 12 months.

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, even if it’s to treat a pre-existing condition. Premiums are based on subscriber age and region of residence in California.

If insurance companies don't spend at least 80 percent of your premium dollar on medical care and quality improvements rather than advertising and bonuses for executives, they will have to provide you a rebate. And, starting September 1, 2011, in every State and for the first time ever, insurance companies are required to publicly justify proposed rate increases of more than 10 percent.

Click here to learn more about California’s Pre-Existing Condition Insurance Plan.


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