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California PCIP (Federal Risk Pool) Opens

The PCIP (Pre-existing Condition Insurance Program), also referred to as the Federal Temporary Risk Pool, is now open and accepting applications for enrollment.

The PCIP is an individuals-only enrollment with no dependents. Rates are set correspondent to the standard rate for a similar $2500 deductible PPO plan on the open market in California. PCIP will use a larger network of providers than MRMIP, approximately 65,000 should be available. The PCIP plan offers both in-network participating benefit levels and and out-of-network non-participating benefit levels.

Applications received by the 10th of the month will be enrolled for the first of the following month.

According to MRMIB, which will run the program for California, agents may assist applicants in the enrollment process for PCIP and receive a $50 fee the same as currently available on the MRMIP program.

Eligibility for the PCIP consists of the following:

1. California state residency as evidenced by applicant having a California address or other appropriate documentation as determined by MRMIB

2. US Citizenship and immigration status for applicants obtained through questions and supporting documentation

3. Applicant has a pre-existing health condition as evidenced by a denial letter from a health insurer or acceptance in a health plan which has rates in excess of PPO rates in the MRMIP (state risk program)

4. Applicant has been without creditable coverage for a least 6 months prior to applying for the PCIP

The California PCIP intends to provide enrollment to an estimated 23,000 California residents. By comparison, MRMIP, the state major risk plan, enrolls a maximum of 7,100. If the PCIP is a maximum enrollment in 2012, the federal government may grant additional funds to the CA PCIP to increase enrollments.

I will place a PCIP application on my web site as soon as it is available for download from MRMIB. It will be available here

Here is the final BROCHURE for the California PCIP including plan summary and rate guide.


  1. Looks like they are delaying the opening of the application process.

    "Applications are anticipated to be mailed by the end of this week due to a slight delay."

    Also now those who want to be put on the mailing list for an application form can email their information to an address ''. A quick look at the Maximus website indicates this is far more than some data-entry operation - although the extent of their involvement with California PCIP is not clear at the moment.

  2. From reading through the MRMIB PCIP information documents, it appears that Maximus will be the plan administrator as well as contract negotiator.

    I knew very little about Maximus. Anthem Blue Cross provides these services for the MRMIP state risk pool.

  3. The PCIP application is up on the MRMIB page. It's currently the first item in the 'What's New' section.

    If I understand the text of the application correctly you MUST apply for both PCIP and MRMIB - but you get to choose PCIP if you are eligible.

  4. Correct. Applicants must submit the MRMIP application with denial letter AND the PCIP Supplemental Application all in one package.

  5. My wife, who has colon cancer, is currently in the MRMIP state high-risk plan. This has an annual cap of $75000, which we run through early each year.

    For obvious reasons we would to enroll her in PCIP, but that requires dropping her from MRMIP and having her go uninsured for 6 months.

    We would do that, despite the risk of major expenses in January, Feb, March, except for one terrifying thought: that PCIP will then be full -- it has limited enrollment -- by the time April 2011 comes around.

    Does anyone know where I can get advice as to the likelihood of PCIP closing enrollment anytime soon? Is anyone else dropping MRMIP for PCIP (which has no annual or lifetime caps, at least for now)?

  6. Anonymous, Sorry I don't have the answer to your question (In fact I doubt anyone can give you an answer with much certainty) but I just wanted to say how sorry I am to see you and your wife caught in such a rotten situation and let you know that I'll be pulling for you two to find a solution.


  7. Hey Dave - with all these carriers leaving the child only market should the PCIP adopt a 'women & children first' policy?! Man the lifeboats folks!

    We're now starting to see the inevitable 'push back' by the insurance industry on the child portion of Reform. It's getting ugly and it'll really start getting ugly for parents who actually have health coverage through a group plan that doesn't insure dependents! Good grief. What a mess.

  8. See today's blog regarding Anthem Blue Cross CA. I expect that Blue Shield CA may have to take the same action so as not to attract the business from Anthem. Kind of like the HIPAA game last winter.

    As of today, only Anthem CA has taken this action, however I expect more fallout in the coming weeks.


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