- Application Assistance Referral
- Invitation to Participate
- PCIP Certification
- Premium Assistance Program
This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
Invitation to Participate (ITP)
The Invitation to Participate (ITP) is the registration process for organizations interested in becoming an Enrollment Entity (EE) for the Pre-Existing Condition Insurance Plan (PCIP). Organizations must qualify under at least one of the categories listed on the ITP form in order to become an EE. Qualified EEs will receive application assistance payments for PCIP certified CAAs whose application assistance results in a successful enrollment in the PCIP program.
Complete ITPs are processed within five business days of receipt. The EE/CAA Liaison Staff will notify your organization in writing when they have completed reviewing your ITP. You will receive a Welcome Letter, Missing Information Letter or a Denial Letter.
Please take the time to review the EE requirements and required documents (listed on the ITP instructions and on the ITP form) to ensure a complete ITP form is submitted. This will ensure your ITP is processed in the most expedient manner.
The authorized contact person for your organization may contact the EE/CAA Liaisons for inquiries or assistance with the ITP at 1-800-279-5012 or email: ee-caaliaison@MAXIMUS.com, Monday through Friday, 8:30 a.m. to 5:00 p.m.
Mail ITPs to:
Pre-Existing Condition Insurance Plan
625 Coolidge Drive, Suite 100
Folsom, CA 95630
or fax to:
Attn: EE Registration
Please download the following documents to begin the Registration process. Complete ITPs include the six page application form, a signed W-9 Tax Form and attached copy of your State License/Certificate or tax-exempt status (see page 2 of ITP for required documents).
Additional forms are available to update an EEs profile:
- Change of Information for EE (PDF 46kb)
- Subsite Address Form (PDF 45kb)
- Add/Remove CAA Form (PDF 37kb)
- CAA Agreement (PDF 58kb)