California Major Risk Medical Insurance Program
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- Patient & State Stability Fund §132 Donald Care High Risk Pools
- PCIP – Pre X Condition Insurance Plan – Historical
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Mr. Mip and PCIP are now combined
MR. MIP (Major Risk Medical Insurance Plan) is a California State Sponsored GUARANTEED ISSUE Plan and covers Pre-Existing Conditions! see brochure for details – partially funded by Tobacco Tax and GUARANTEES coverage to individuals unable to get it through a regular Insurance Company or HMO. Mr. MIP is similar to a High Risk or Assigned Risk Plan for Auto Insurance. There may be a waiting list to get into Mr. MIP…1-800-289-6574
Learn about AB 1887
Mr. MIP information is posted as a Public Service (Leviticus 19:9). We suggest you contact and submit your application to Mr. MIP directly. If we write other business for you or your family, we are happy to consult with you on this coverage.
Customer Service Contact Info. Explanatory Info. on CA DOI Website.
CA Insurance Commissioner now posts Underwriting – Pre-Existing Guidelines
80% have less than $5K in claims – Page VII 61 Mr. Mip Report Click on screen below to enlarge
Wait(ing) list status for the Major Risk Medical Insurance Program (MRMIP); however, slots are limited. We recommend that you get your application in as soon as possible because when there is a wait list, slots are offered by the first complete applications received.
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California Insurance Code on Mr. Mip PART 6.5. For 29 pages of detail, on how it’s funded, and technical stuff click here.
California Healthline 3/20/2010 article on challenges in creating high risk pool
Insurance Code §12725.5. (a) It shall constitute unfair competition … for an insurer, an insurance agent or broker, or an administrator, … to refer an individual employee, or his or her dependents, to the program, or arrange for an individual employee, or his or her dependents, to apply to the program, for the purpose of separating that employee, or his or her dependents, from group health coverage provided in connection with the employee’s employment. (b) …for any employer to refer an individual employee, See page 27 Question 6 of the application 6. I declare that no individual listed on this application was excluded from group health coverage solely for the purpose of being made eligible for the MRMIP.
BILL NUMBER: AB 1887 AMENDED BILL TEXT AMENDED IN ASSEMBLY MAY 28, 2010 AMENDED IN ASSEMBLY APRIL 28, 2010 INTRODUCED BY Assembly Member Villines (Coauthor: Assembly Member Monning) FEBRUARY 16, 2010 An act to add Part 6.45 (commencing with Section 12699.70) to Division 2 of the Insurance Code, relating to health care coverage , and declaring the urgency thereof, to take effect immediately . LEGISLATIVE COUNSEL’S DIGEST AB 1887, as amended, Villines. Temporary high risk pool. Existing law, the federal Patient Protection and Affordable Care Act, requires the United States Secretary of Health and Human Services to establish a temporary high-risk high risk health insurance pool program to provide health insurance coverage for eligible individuals until January 1, 2014 . Existing law authorizes the secretary to carry out this program directly or through contracts to eligible entities, including states, and requires that money made available pursuant to these provisions be used to establish a qualified high risk pool that meets certain requirements. Existing law establishes the California Major Risk Medical Insurance Program, which is administered by the Managed Risk Medical Insurance Board (MRMIB), to provide major risk medical coverage to persons who, among other matters, have been rejected for coverage by at least one private health plan. This bill would require MRMIB to establish a temporary high risk pool to provide health care coverage to specified individuals who have preexisting conditions and have not been covered under creditable coverage, as defined, for the 6 months prior to applying for coverage in the pool. The bill would require coverage in the pool to meet specified requirements and would require premiums to be established at a standard rate for a standard population and not have an age rating greater than 4 to 1. The bill would require MRMIB to apply for federal funding in order to operate the pool and would enact other related provisions. The bill would declare that it is to take effect immediately as an urgency statute. Vote: majority 2/3 . Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Part 6.45 (commencing with Section 12699.70) is added to Division 2 of the Insurance Code, to read: PART 6.45. TEMPORARY HIGH RISK POOL 12699.70. For purposes of this part, the following definitions shall apply: (a) “Board” means the Managed Risk Medical Insurance Board created pursuant to Section 12710. (b) “Creditable coverage” has the same meaning as defined in Section 10198.6. (c) “Pool” means the temporary high risk pool established by the board pursuant to this part. 12699.72. (a) The board shall establish a temporary high risk pool to provide health care coverage to eligible individuals. (b) Each individual who meets all of the following requirements is eligible to apply for coverage through the pool: (1) Is a citizen or national of the United States, or is lawfully present in the United States, as determined in accordance with Section 1411 of the Patient Protection and Affordable Care Act (Public Law 111-148). (2) Has not been covered under creditable coverage for the six months prior to applying for coverage through the pool. (3) Has a preexisting condition. (c) The benefits and coverage provided through the pool shall, at a minimum, have an actuarial value of at least 65 percent of total allowed costs, an out-of-pocket limit no greater than the applicable amount for high deductible health plans linked to health savings accounts, and no preexisting condition exclusions. (d) Premiums for coverage provided through the pool shall be established at a standard rate for a standard population and not have an age rating greater than four to one. (e) The board shall apply for federal funding pursuant to Section 1101 of the Patient Protection and Affordable Care Act (Public Law 111-148) to operate the pool created by this part. 12699.74. Nothing in this part shall be construed to preclude the board from creating more expansive standards and benefits, lower cost-sharing requirements, or eligibility criteria that would result in the inclusion of more enrollees if permitted under federal law and funded exclusively with federal funds. SEC. 2. This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are: In order to allow the state to apply for federal funding made available by Section 1101 of the federal Patient Protection and Affordable Care Act (Public Law 111-148) at the earliest possible time, it is necessary that this act take effect immediately.
Proposal from Federal Government to States to Offer High Risk Pool Program
A.1 PURPOSE AND BACKGROUND The Department of Health and Human Services (HHS), as provided by Section 1101 of the Patient Protection and Affordable Care Act (?Affordable Care Act,? Public Law 111-148) seeks contracts with States to establish and operate temporary high risk health insurance pool programs to provide coverage for eligible individuals beginning in 2010 and ending on December 31, 2013. This solicitation seeks proposals from States that wish to enter into noncompetitive contracts with HHS to establish and administer these high risk pools.
PART 6.5. CALIFORNIA MAJOR RISK MEDICAL INSURANCE PROGRAM
CHAPTER 1. GENERAL ……………………………………….. 12700 CHAPTER 2. DEFINITIONS ……………………………………. 12705
CHAPTER 3. POWERS AND DUTIES ………………………….. 12710-12714
CHAPTER 4. POLICIES ISSUED BY THE BOARD ………………… 12715-12718
CHAPTER 5. PARTICIPATING HEALTH PLANS ………………….. 12720-12723
CHAPTER 6. SUBSCRIBER ELIGIBILITY AND ENROLLMENT ………… 12725-12733
CHAPTER 7. PLAN RATES AND COMPENSATION FROM THE FUND …….. 12735-12738
CHAPTER 8. MAJOR RISK MEDICAL INSURANCE FUND ………….. 12739-12739.4
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