California Pre-Existing Condition Insurance Plan (PCIP) 
Do you have a pre-existing conditionPATIENT FAQ 

The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition.  This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people if they have had a problem getting health insurance due to a pre-existing condition. 

How do I know if I am eligible for coverage through PCIP?*

Eligible individuals must:

  1. Must be a California resident.
  2. Be a U.S. citizen or a legal resident: U.S. Citizens or U.S. Nationals must provide their Social Security Number.
  3. Must have been uninsured for at least the last six months before applying for coverage (proof of denial from insurance company will be needed).
  4. Must have a pre-existing medical condition and not have been covered under health coverage for the previous 12 months, or have been offered individual health insurance coverage at a premium rates higher than the California Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) within the last 12 months.

How do I enroll?

Download application at Complete both the PCIP Supplemental Application and the Major Risk Medical Insurance Program (MRMIP) Application and mail to:

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

When will my PCIP coverage be effective?

Once the PCIP application is complete with all the required documentation and processed by the 10th of the month, coverage will begin the 1st day of the following month. For example:  If the applicant enrolled between 8/1/2010-8/10/2010, they are effective 9/1/2010.

How much does it cost me?**

Monthly premiums range from $127 to $1,003 per month depending on age and the region you live in within California.

What benefits do I receive under PCIP?

Covered In-Network Services:

  • $1,500 annual deductible (except for preventive services, which have no copay or deductible)
  • Patient pays 15% of the cost of covered benefits
  • Preventive services include: periodic health evaluations (ie. annual physicals), screening services (ie. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.

*Persons currently covered by a health plan, including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs, are not eligible for the Pre-Existing Coverage Insurance Plan. PCIIP coverage is only available to an eligible individual. There are no family plans or premium levels in PCIP.

**Premiums may be subject to changes made by PCIP.