PPACA Blog

Aug 30, 2010

Individuals with Preexisting Conditions Get a New Option in September


Category:PPACA 
Posted by: Neal

The Managed Risk Medical Insurance Board will begin accepting applications this month and providing coverage to Californians next month for a new health insurance program for individuals with preexisting conditions. It’s one of first major provisions of federal health reform to be implemented in California. The Preexisting Condition Insurance Plan (PCIP) will provide coverage to uninsured individuals who have been denied health insurance or have been offered only unaffordable options.

Premiums will range from $127 a month for children 15 and under in the three most southern counties to $1,003 a month for people over 74 in the Bay Area. For example, the monthly premium would be $499 for a 50-year-old in San Francisco compared to $915 for the state’s high-risk pool. Rates are effective through December 31, 2011.

To be eligible for PCIP, a person must be a citizen, national, or lawfully present in the United States. They must have had no creditable coverage six before applying and have a preexisting condition as evidenced by proof of denial by an insurance carrier in the past 12 months or an offer of coverage above the premium level of the MRMIP PPO rate. So far, nearly 4,000 people requested the PCIP application. Anyone who is interested in an application should submit their name, address, phone number and email address to PCIP@mrmib.ca.gov.

The Board is negotiating with two organizations to operate as administrative vendor and third-party administrator for the program – MAXIMUS, a Virginia-based private company with offices in Folsom, Calif. And HealthNow Administrative Services. They will provide a structure similar to what is in use with self-insured employers.

California will receive a federal allocation of $761 million to operate the plan through the end of 2013 when preexisting conditions are no longer considered in insurance pricing and eligibility under the new health reform law. For more information, visit www.mrmib.ca.gov.

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