This page is informational and historical only.
Click here for GUARANTEED Issue coverage in CA under Health Care Reform or here if you are not in CA.
|California Pre-Existing Condition Plan & Mr. MIP
Like Cancer & Diabetes
“Guaranteed Issue”Free Google tool to Fill in pdf’s that do not have fieldsCertified AgentBlue Cross request for denial and Major Risk Letter pdf
|Enrollment in PCIP ends 3.2.2013!. pcip.ca.gov Washington Post This was due to 1,000% claims ratios MR. MIP is still available.First available in 2010 and funded in large part by the federal government, it was sold “guaranteed issue.” This meant one couldn’t be turned down because of pre-existing conditions. The government projected 375,000 people would sign up initially, but instead only 21,000 people did so.
Maybe if they had paid a decent commission, agents would have promoted it more. Let alone the service level to agents SUCKED!
As it turned out, those who signed up had more expenses on average than the government projected.
In other words, what happened with the PCIP is similar to what we see happening right now with the exchanges. With the PCIP, the government reacted by shutting it down. Only so much money had been allocated to the program, so the government had to stop it.Tennesian.com
The Affordable Care Act of 2010 set up a temporary high risk pool program aka PCIP to provide health coverage for eligible individuals and Self Employed that do not qualify for AB 1672 Small Group Guaranteed Issue Health Coverage, until December 31, 2013 when the national health reform is set to begin. This program is available for individuals who have not had health coverage in the 6 months prior to applying.
Find out if you qualify for a Preferred Underwritten Plan
Pre Application Underwriting FORMS
|If you are NOT in CA, check this out
Types of Medical Issues that will probably be covered by PCIP, Get Med 360 Check brochure and Full Policy (EOC) for details
- Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process;
- Cancer, under treatment;
- Sleep Apnea;
- Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities;
- Heart disease;
- Renal failure or Kidney Dialysis;
- Diabetes with complications;
- Multiple Sclerosis;
- Muscular Dystrophy;
- Systemic Lupus Erythematous;
- History of transplant;
- Current infertility treatment;
- Stroke, after 10 years with no reoccurring problems;
- Allergies, while testing is in process;
- Ear infections, controlled with medications;
- Lyme disease, without symptoms after one year;
- Breast Implants (non-silicone);
- Joint sprain or strain, recovered and no restrictions;
- Migraine headache, mild and infrequent with no emergency room visits;
- Mild depression.
height and weight when I apply for insurance?
smoking and drinking history
AIDS Automatic decline
Pregnancy, pregnancy of your spouse or significant other, planned surrogacy or adoption in process Automatic decline
Cancer, under treatment Automatic decline
Sleep Apnea Automatic decline or higher premium will be charged
Severe mental disorders, such as major depression, bipolar disorder, schizophrenia or psychopathic personalities Automatic decline
Heart disease Automatic decline
Renal failure or Kidney Dialysis Automatic decline
Diabetes with complications Automatic decline
Cirrhosis Automatic decline
Multiple Sclerosis Automatic decline
Muscular Dystrophy Automatic decline
Systemic Lupus Erythematous Automatic decline
History of transplant Automatic decline
Lymphedema Automatic decline or higher premium will be charged
Current infertility treatment Automatic decline
Hepatitis Automatic decline
Hemochromatosis Automatic decline
Rheumatoid Arthritis Automatic decline
Stroke, after 10 years with no reoccurring problems Automatic decline or higher premium will be charged
Allergies, while testing is in process Automatic decline or higher premium will be charged
Ear infections, controlled with medication Higher premium may be charged
Lyme disease, without symptoms after one year Automatic decline or higher premium will be charged
Breast Implants (non-silicone) Automatic decline or higher premium will be charged
Ringworm Higher premium may be charged
Joint sprain or strain, recovered and no restrictions Higher premium may be charged
Migraine headache, mild and infrequent with no emergency room visits Higher premium may be charged
Mild depression Automatic decline or higher premium may be charged
Obesity Automatic decline or higher premium may be charged
STD (Sexually Transmitted Disease) Automatic decline or higher premium may be charged insurance.ca.gov
Medical Necessity & Criteria to get above procedures covered by your Insurance.
Funding for subsidies AB 1526 (2012)
Blue Shield kicked out of Mr. MIP premiums too high LA Times 2009
PCIP Agent Certification
Interim Final Rule Pre-Existing Condition Insurance Plan
Federal Regulations & Guidance CMS
TITLE 45–Public Welfare
SUBTITLE A–DEPARTMENT OF HEALTH AND HUMAN SERVICES
SUBCHAPTER B–REQUIREMENTS RELATING TO HEALTH CARE ACCESS
PART 152–PRE-EXISTING CONDITION INSURANCE PLAN PROGRAM
Subpart A–GENERAL PROVISIONS
Subpart B–PCIP PROGRAM ADMINISTRATION
Subpart C–ELIGIBILITY AND ENROLLMENT
|Enrollment and disenrollment process.
|Prohibitions on pre-existing condition exclusions and waiting periods.
|Premiums and cost-sharing.
|Preventing insurer dumping.
|Initial allocation of funds.
Subpart G–RELATIONSHIP TO EXISTING LAWS AND PROGRAMS
Subpart H–TRANSITION TO EXCHANGES
|End of PCIP program coverage.
|Transition to the exchanges.
Fact Sheet – Comparison of MR MIP and Obama’s Plan
Info on HealthCare.Gov
Section 1101: ESTABLISHES AN INTERIM HIGH RISK POOL PROGRAM
6/28/2010 Calif Health Line – Status on Pending CA Bills
6/22/2010 Sacramento Bee Article
Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition.
Establishes a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions.
- U.S. citizens and legal immigrants who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums.
- Premiums for the pool will be established for a standard population and may vary by no more than 4 to 1 due to age;
- Maximum cost-sharing will be limited to the current law HSA limit ($5,950/individual and $11,900/family in 2010).
- The law appropriates $5 billion to finance the program.
- The new pools are to be administered directly by a state or a nonprofit entity under contract. States may not reduce their current high risk pool efforts.
Premiums in the new federal pool are expected to be 10 percent to 50 percent lower than current state rates, said Richard Popper, who directs Maryland’s program. Co-payments and deductibles are also expected to be considerably lower. But the only way current beneficiaries could get the federal coverage would be to drop out of their state pool and go uninsured for six months.
(Effective within 90 days of enactment: June 21, 2010, until January 1, 2014)1
California AB 1887 by Assm. Villines (R)
Would establish a federally qualified high-risk insurance pool for individuals who are unable to obtain private coverage because of a pre-existing condition.
California already has a high-risk insurance pool that covers about 7,000 residents, but it does not meet requirements to qualify for federal subsidies under the new health reform law. Authorizes the existing MR MIP to apply for any federal funding the board determines to be cost effective for purposes of extending major risk medical coverage. to more applicants.
See also SB 227
Types of medical illness