This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).

Who Can Qualify?

UPDATE Effective March 3, 2013: Following federal direction, received on February 15, 2013, California PCIP has suspended new enrollments for applications received after March 2, 2013. Applications received after March 2, 2013, will be screened for California's high risk pool, Major Risk Medical Insurance Plan (MRMIP) eligibility. Read More...

The PCIP eligibility requirements are:

• You are a resident of California.
• You have a pre-existing condition as shown by:
  • A denial letter from a health insurance company or health plan dated within the last 12 months, or
  • A letter (PDF 22kb) from a licensed doctor, physician assistant, or nurse practitioner dated within the past twelve (12) months, stating that the individual has or had, a medical condition, disability, or illness, or
  • An offer of individual (not group) health coverage with higher premiums than the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) rate in the area where you live. See MRMIP PPO monthly premiums (PDF 68kb) page 10 - 15 of the PCIP/MRMIP Handbook. The offer letter must be dated within the last 12 months, or
  • A certificate of creditable coverage letter issued by another state or Federally administered PCIP program showing previous enrollment within the past 6 months (see page 23 of the PCIP/MRMIP Handbook (PDF 1,600kb) for more details).
• You are not enrolled in Medicare Part A and B, COBRA, or Cal-COBRA benefits.
• You are a U.S. Citizen or U.S. National – or you are lawfully
  present in the U.S. (you must provide a Social Security Number if you are a U.S. Citizen or U.S. National).
• You have not had health coverage for at least 6 months.

If you have questions on PCIP eligibility requirements, please give us a call at 1-877-428-5060, Monday - Friday, from 8 a.m. to 8 p.m. Or, on Saturday, from 8 a.m. to 5 p.m.

Who can be an applicant?

Any person of any age that meets the PCIP Eligibility requirements. The following individuals can be an applicant:

• Person 18 years of age or older who are applying for coverage himself/herself;
• Parents (natural or adoptive);
• Legal Guardians;
• Stepparents;
• Foster parents;
• Caretaker relatives for a minor;
• Minor not living with persons listed above (i.e. emancipated minor)

However, each individual applying for the PCIP must complete their own application, because the PCIP does not offer dependant coverage.

How do I apply for PCIP?

To apply for PCIP, you must complete the four-page PCIP/MRMIP Application (PDF 122kb).

Find out which program is right for you. The PCIP/MRMIP Worksheet (PDF 44kb) will help you understand if you could qualify and which program is better for you.

When you review the application, it is important that you carefully review the PCIP/MRMIP Handbook (PDF 1,600kb) which contains a Checklist. The Checklist explains the supporting documents and monthly premium you need to send with your application.

Use your legal name when completing your application. Your legal name should match the name issued on your citizenship or immigration documents that you submit with your application. However, if your name does not match your citizenship or immigration documents and you prefer to use your married name, shortened name, or nickname on your application, you need to submit a copy of one of the following documents:

• Unexpired California Driver’s License or California Identification Card.
• Marriage License or Marriage Certificate issued from local or state Office of Vital Statistics.
• A Legal Name Change document that contains the legal name both before and after the name change.
• Adoption documents that contain the legal name as a result of the adoption.
• Dissolution of Marriage document that contains the legal name as a result of court action.
• A Domestic Partnership Certificate, Declaration, or Registration document verifying formation of a domestic partnership.

Mail the application, first month's premium and all necessary documents to:

Pre-Existing Condition Insurance Plan
P.O. Box 537032
Sacramento, CA 95853-7032

If you have questions when you fill out the application, please give us a call at 1-877-428-5060, Monday - Friday, from 8 a.m. to 8 p.m. Or, on Saturday, from 8 a.m. to 5 p.m.

Important Notice:

If you are currently or will be enrolled in the MRMIP, you will not qualify for the PCIP. The PCIP requires that an individual not have health insurance coverage for at least 6 months.

Application Assistance – Get Help Applying

Get help in person from an Insurance Agent, Broker or Certified Application Assistant

Insurance Agents, Brokers and Certified Application Assistants (CAAs) are people who have been trained to help you fill out the PCIP/MRMIP Application.

FIND APPLICATION ASSISTANCE IN YOUR AREA

To find application assistance in your area, enter your zip code, city, or county below and click the "Search" button.

Zip Code: or

City: Select your City >>AlamedaAlhambraAliso ViejoAnaheimApple ValleyAptosArcadiaArcataArroyo GrandeAuburnAzusaBakersfieldBanningBellBellflowerBeniciaBeverly HillsBig Bear LakeBorrego SpringsBoyes Hot SpringsBreaBuena ParkBurbankBurlingameCalabasasCalistogaCalpellaCamarilloCampbellCapitolaCarlsbadCarsonCathedral CityCerritosChicoChinoChino HillsChula VistaCity Of IndustryClaremontClaytonCloverdaleClovisCoarsegoldCoronaCosta MesaCottonwoodCovinaDana PointDavisDiamond BarDowneyEl CajonEl CentroEl MonteEl SobranteElk GroveEncinaEncinoEscalonEscondidoExeterFairfaxFairfieldFall River MillsFallbrookFontanaFort BraggFortunaFrench CampFresnoFullertonGardenaGilroyGlendaleGlendoraGranada HillsGranite BayGrass ValleyGuernevilleHawaiian GardensHayforkHaywardHealdsburgHemetHuntington BeachHuntington ParkIndioInglewoodIrvineKelseyvilleLa MesaLa MiradaLa QuintaLaguna HillsLakewoodLamontLemon GroveLincolnLodiLompocLong BeachLos AlamitosLos AngelesMaderaMammoth LakesMarinaMartinezMarysvilleMercedMilpitasMira LomaMission ViegoMission ViejoModestoMonterey ParkMoreno ValleyMt. ShastaMurrietaNapaNevada CityNewport BeachNewport CoastNorcoNorth HollywoodNorthridgeNorwalkNovatoOaklandOceansideOjaiOntarioOrangeOrovilleOxnardPacoimaPalm DesertPalm SpringsPalmdalePalo AltoPanorama CityPasadenaPattersonPetalumaPiedmontPismo BeachPlacentiaPlacervillePleasantonPomonaPortervillePowayQuincyRail Road FlatRancho CucamongaRancho MirageRancho Santa MargaritaReddingRedlandsRialtoRiversideRosemeadRosevilleSacramentoSaint HelenaSan BernardinoSan DiegoSan DimasSan FranciscoSan GabrielSan JoseSan LeandroSan Luis ObispoSan MarcosSan MateoSan YsidroSanta AnaSanta BarbaraSanta ClaraSanta CruzSanta RosaSaratogaSelmaShafterShasta LakeSignal HillSimi ValleySolvangSonomaSonoraSouth Lake TahoeSouth San FranciscoSpreckelsSpring ValleyStocktonSun CitySunnyvaleSusanvilleSutter CreekTarzanaThousand OaksTorranceTrabuco CanyonTracyTurlockTwentynine PalmsUkiahUplandValenciaValley CenterValley VillageVan NuysVenturaVictorvilleVisaliaVistaWalnutWalnut CreekWascoWatsonvilleWest CovinaWestlake VillageWestminsterWhittierWilliamsWindsorWinnetkaWoodlakeWoodlandWoodland HillsYuba City or

County: Select your County >>AlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYuba

         

What documents must I send when applying for PCIP?

Your PCIP/MRMIP Application must contain the following:

• A personal check, cashier's check or money order for one month’s premium payable to the Managed Risk Medical Insurance Board (MRMIB) in the amount for the program you prefer on the PCIP/MRMIP Application, question #2.

Your monthly PCIP premiums are based on your age and where you live. Your monthly MRMIP premiums are based on your age, where you live, and number of dependent(s), if any. Click here for PCIP and MRMIP Monthly Premiums (PDF68kb) (i.e. just applying for yourself - PCIP, yourself plus dependent - MRMIP).

• You must have been denied individual insurance coverage within the past 12 months, for a pre-existing condition as shown by:
  • A denial letter from a health insurance company or health plan in the last 12 months, or
  • A letter (PDF 22kb) from a licensed doctor, physician assistant, or nurse practitioner dated within the past twelve (12) months, stating that the individual has or had, a medical condition, disability, or illness, or
  • An offer of individual (not group) health coverage at higher premiums higher than those the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) rate where you live. See MRMIP PPO monthly premiums (PDF 68kb) page 10 - 15 of the PCIP/MRMIP Handbook. The offer letter must be dated within the last 12 months, or
  • A certificate of creditable coverage letter issued by another state's or Federally administered PCIP program showing previous enrollment within the past 6 months (see page 23 of the PCIP/MRMIP Handbook (PDF 1,600kb) for more details
• Proof of U.S. Citizen/U.S. National shown by providing:
  • U.S. Passport;
  • Birth certificate;
  • Naturalization/Citizenship certificate;
  • American Indian or Alaska Native enrollment document from a federally recognized tribe;
  • A Certificate of Degree of Indian Blood (CDIB) from the Bureau of Indian Affairs; or
  • A letter of Indian Heritage from a California Indian Health Service Clinic.
• Proof of noncitizen who is lawfully present in the U.S. shown by providing unexpired immigration documents or unexpired immigration card copies of the front and back sides. Please make sure the immigration documents or immigration card show the expiration date and has not expired.

Acceptable Noncitizen Immigration Documentation and Immigration Cards*
1. I-327 (Reentry Permit)
2. I-551 (Permanent Resident Card)
3. I-571 (Refugee Travel Document)
4. I-766 (Employment Authorization Document (excluding Category Code C33))
5. Machine Readable Immigrant Visa (with Temporary I-551 Language) affixed to Unexpired Foreign Passport
6. Temporary I-551 Stamp (on passport or by I-94) affixed to I-94 or Unexpired Foreign Passport
7. I-94 (Arrival/Departure Record) with Unexpired Foreign Passport
8. Unexpired Foreign Passport for Visa Waiver Program travelers
9. I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status) accompanied by I-94 and an Unexpired Foreign Passport
10. DS-2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) accompanied by an I-94 Unexpired Foreign Passport
11. Other Document (such as a Visa) with an I-94

*For more information regarding noncitizen immigration documentation, please go to the U.S. Citizenship and Immigration Services (USCIS) website at: www.uscis.gov and/or to the U.S. Department of State Bureau of Consular Affairs website at: http://travel.state.gov/