Pre-existing conditions-finally some relief

October 1, 2010 marks the opportunity for those individuals with pre-existing conditions to obtain coverage.  The federal health reform law known as Patient Protection and Affordability Care Act (PPACA) includes the Pre-existing Condition Insurance Plan (PCIP) which is one of the first major provisions of federal health reform to be implemented in California.

California’s high risk pool, MRMIB program has been available for people who have been uninsurable in the past but with plan design limitations.  The plan design requirement from the federal health reform changes the design of the plan as well as qualification and rates.  There is a federal allowance of $761 million to operate the plan through the end of 2013.  At that time (2014) pre-existing conditions will no longer be part of the insurance pricing and eligibility under the new health reform law.

Here’s the skinny on the plan:

Eligibility:

• Must be a citizen of the US, US national or lawfully residing in the US
• A resident of California
• Must be uninsured for at least 6 months
• Must provide proof that the individual applying has been declined by an insurance carrier due to pre-existing conditions (yes this means you have to go through the application process with a carrier prior to applying and have a declination letter) within the last 12 months

Exceptions:

• None
• Cannot move from high risk pool plan (for example HIPAA plan)
• Cannot move from COBRA

Premiums:

• Since there is no higher charge due to pre-existing conditions, premiums remain consistent (plan is subsidized by the federal government)
• Eligibility is not based on income
• Premiums are based on the age of the individual

Plan Design:

• Plans cover primary care, specialty care, hospitalization and prescription drugs without regard to pre-existing conditions
• Annual deductible $1500
• Office visit co-pay, primary care $30, specialty care $45
• Out of pocket maximum $2500

Effective Date

• Applications received between the 1st and the 15th of the month are effective the first of the following month
• Applications received between the 16th and the end of the month effective the fist of the following month

Other Important Things to Know:

• Pre-existing conditions include disability, illness, mental and physical
• MRMIB started accepting application August 31, 2010

For additional information, please contact MRMIB’s PCIP directly:

www.pcip.ca.gov

Of course all things are subject to change and I will keep you posted as I hear of updates.