Pre-Existing Condition Insurance Plan: California

Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice.  PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.  We encourage you to visit http://finder.healthcare.gov to explore your other health care options.

Note: If you lost PCIP coverage during the past 6 months because you moved out of state, you may be eligible to re-enroll in PCIP in your new state of residence. Please call 1-866-717-5826 (TTY: 1-866-561-1604), Monday – Friday, 8 a.m. to 11 p.m. EST, if you believe you are eligible.

Why is PCIP enrollment being suspended?
PCIP is a temporary program for those locked out of the current insurance marketplace. The program has a limited amount of funding from Congress.

Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs.  More information can be found in the Annual Report on the Implementation and Operation of the PCIP Program at http://www.cciio.cms.gov/resources/files/pcip_annual_report_01312013.pdf.

This suspension will help ensure that funds are available through 2013 to continuously cover people currently enrolled in PCIP.

The Health Insurance Marketplace
Starting next year, the Affordable Care Act guarantees that all Americans – regardless of their health status or pre-existing conditions – will finally have access to quality, affordable coverage.  People will be able to apply for affordable health insurance coverage choices in Health Insurance Marketplaces when open enrollment begins on October 1. The Health Insurance Marketplace will offer a choice of quality, affordable health plans. Coverage begins on January 1, 2014. Visit www.healthcare.gov/marketplace to learn more about the Marketplace.

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.

To contact this program, please call 1-877-428-5060 Monday-Friday, 8 a.m. to 8 p.m. or, on Saturday, 8 a.m. to 5 p.m. or go to www.pcip.ca.gov.

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