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Pre-Existing Condition Insurance Plan Open for Business

Californians who have been denied coverage because of pre-existing health conditions and have been uninsured for at least six months are now eligible for the state’s new Pre-Existing Condition Insurance Plan (PCIP).

Created by the federal Affordable Care Act of 2010, the PCIP is one of the first major provisions of national health care reform to take effect and is designed to bridge the gap between now and 2014, when insurers will no longer be allowed to decline health coverage or charge higher premiums to individuals with pre-existing conditions.

The plan covers inpatient and outpatient care provided by doctors, psychologists, hospitals, laboratories and imaging centers, as well as generic and brand-name drugs. Compared with the state Major Risk Medical Insurance Program (MRMIP), it offers lower premiums, expanded coverage and no lifetime limits. PCIP premiums are generally 40 percent less than MRMIP’s—and cost about what a subscriber without preexisting conditions would pay for an individual plan on the open market.

To qualify for the PCIP, a person must meet the following eligibility requirements:

  • You must be California resident.
  • You must have no health insurance coverage for the past 6 months, prior to application being received. This means in the last 6 months you were not enrolled in an individual or job-based health plan, including COBRA or Cal-COBRA, or enrolled in Medicare Part A and/or Part B, or in No-Cost Medicaid/No-Cost Medi-Cal.
  • You must be a U.S. Citizen, U.S. National, or lawfully present individual.
  • U.S. Citizens or U.S. Nationals must provide their Social Security Number.

You must have been denied individual insurance coverage within the past 12 months, for a pre-existing condition as shown by:

  • Rejection letter from a health insurance company in the last 12 months, or
  • Offered coverage with premiums higher than those of the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) in the geographic region where the individual is seeking coverage.

Californians interested in coverage under the Pre-Existing Condition Insurance Plan are encouraged to go online or call 1-877-428-5060 for more information.

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