- Who can qualify?
- Who can be an applicant?
- How do I apply?
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- What documents must I send when applying for PCIP?
- Frequently Asked Questions
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This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
Pre-Existing Condition Insurance Plan (PCIP) and Major Risk Medical Insurance Program (MRMIP) Differences
The California Major Risk Medical Insurance Program (MRMIP) is a separate state program also run by MRMIB for medically uninsurables with different eligibility rules, annual deductibles, annual/lifetime cap, and monthly premium costs compared to the PCIP.
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 coverage for at least six (6) months, prior to receiving your application.
When you apply for the PCIP and/or MRMIP, your application will be reviewed for both health care programs to inform you of your coverage options. In order for your eligibility to be determined for each program, you need to fill out the PCIP/MRMIP Application. If you qualify for both programs, we will enroll you in the program that you prefer in question #2. If you do not select a program, we will enroll you in PCIP. The MRMIP has an enrollment cap which limits the number of individuals that can be enrolled.
The PCIP and MRMIP have different eligibility rules, benefits and costs. The charts below compare the two programs.
PCIP and MRMIP Eligibility Rules
|You may qualify for
PCIP (Pre-Existing Condition Insurance Plan) if:
|You may qualify for
MRMIP (Major Risk Medical Insurance Program) if:
Deferred enrollment: If you have health coverage but it is going to end soon, you may apply now for MRMIP. This is called deferred enrollment. Get a letter from your health plan or employer that says when your coverage will end.
Medi-Cal: If you receive Medi-Cal benefits now and want to switch to MRMIP, consider the cost.
PCIP and MRMIP Benefits
|Annual medical deductible||$1,500||$500 / subscriber or subscriber and dependents|
|Brand name drug deductible||$500||None|
|Annual out-of-pocket maximum||$2,500||$2,500 / $4,000 subscriber and dependents|
|Annual benefit maximum||None||$75,000|
|Lifetime benefit maximum||None||$750,000|
|Health care provider source||PCIP PPO Network
(see pages 14 – 19 of the PCIP/MRMIP Handbook)
Anthem Blue Cross, Contra Costa Health Plan, Kaiser (see pages 14 – 19 of the PCIP/MRMIP Handbook)
|Pre-existing condition exclusion or
Post-enrollment waiting period
|None||3 months (see page 22 of the PCIP/MRMIP Handbook)|
Download a printable version of PCIP and MRMIP Costs and Benefits Chart (PDF 284kb) or a PCIP/MRMIP Application (PDF 122kb).