More about California’s Preexisting Conditions Health Insurance Pool

20 July 2010 |

In my last post, I discussed California’s response to the federal mandate to create a high-risk health insurance pool for people who have been denied private health insurance due to preexisting medical conditions.

While researching that post, I went to the federal government’s health care insurance Web portal at http://www.healthcare.gov and followed the links to the California site. I clicked the link to receive an email about applying for the high-risk health insurance pool. Today I received an email response from the state of California:

Hello:

Thank you for your interest in California’s Pre-existing Conditions Insurance Plan (PCIP), also known as the temporary federal high risk pool.  Currently, we do not have applications available for the PCIP. The Managed Risk Medical Insurance Board (MRMIB) continues discussions on the specific rules for developing, implementing and operating the PCIP.

California’s goal for implementing the PCIP is to begin accepting applications in August 2010 with the first effective date of coverage beginning in September 2010.

To be eligible for the new PCIP, federal law sets out three requirements:

1. Be a US Citizen, US National or lawfully present individual;

2. Have a pre-existing medical condition that meets the guidelines set by the federal government; and

3. Have not had health insurance or public health coverage for at least six (6) months.

Applicants must have been uninsured for at least six months at the time they apply for the PCIP but the State high risk pool does not have such a requirement. You can access info on the CA Major Risk Medical Insurance Program at http://www.mrmib.ca.gov/MRMIB/MRMIP.shtml.

If you have included your name, address, telephone number, and email address, we will place your name on the list for a PCIP application when they are available in the next month or so.  If you have not included this information, please re-submit your request with that information.

We will be posting updates on MRMIB’s website under “What’s New” on the homepage at http://www.mrmib.ca.gov/.  Also, if you know others who want a PCIP application ask them to send us an email with their name, address, telephone number and email address to FHRP@mrmib.ca.gov.

Again, thank you for your interest in California’s PCIP.

I hope this helps anyone who has been denied coverage due to preexisting medical conditions.


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Preexisting Conditions Health Insurance Pool To Open

15 July 2010 |

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act—the national health insurance reform legislation—into law. The PPACA contains a provision requiring the federal government to establish a temporary high-risk health insurance pool no later than 90 days after the bill was signed to insure people who have been denied coverage because of preexisting conditions.

This high-risk pool will last only until December 31, 2013. Beginning January 1, 2014, all health insurance providers will be required to cover preexisting conditions. (To see what I think the long-term effects of this provision will be, please see my previous posts.) In the mean time, Kathleen Sebelius, Secretary of the Department of Health and Human Services (DHHS) sent a letter to the governors of the fifty states, asking how each state will administer the temporary high-risk pool. Health care insurance consumers who have been denied coverage for preexisting conditions can begin to enroll in new “high-risk” health insurance pools administered by the Department of Health and Human Services.

On April 29, 2010, Governor Arnold Schwarzenegger indicated that California would contract with the federal government to operate a temporary health insurance program of currently uninsured individuals with preexisting medical conditions. The governor stated that California would operate the temporary high risk pool alongside the state’s high risk pool, the Major Risk Medical Insurance Program (MRMIB), using the same operational framework. The MRMIB is a public-private partnership that uses contracted vendors monitored by the MRMIB to provide health insurance coverage through a variety of programs, including California’s Health Insurance Program (CHIP), also known as the Healthy Families Program.

The eligibility criteria for the temporary high-risk plans will be different than those for existing programs. Here is an overview of the temporary high-risk insurance program:

Who is eligible? Eligibility is limited to American citizens or legal residents who have not had health insurance for at least six months because they were denied coverage because of a pre-existing medical condition. You will need a letter from a private health insurance provider stating that you were denied coverage altogether or for a specific condition.

How much will health insurance from the high-risk pool cost?

California has yet to choose the vendor whose plan will be implemented, but even with the federal subsidy premiums are expected to range from $400 to $1,200 per month, depending on factors such as age and gender. As with typical plans, the high-risk policies will have annual deductibles that could range as high as $3000 for individuals and $6000 for families.

Can the states afford to cover everyone?

The Congressional Budget Office (CBO) estimates that the PPACA will cost taxpayers $1.05 trillion over the first 10 years, but less than one-half of one percent of that—a mere $5 billion—has been set aside to fund the high-risk pools. The CBO estimates that the program will run out of funds in two years, depending on demand. The Department of Health and Human Services has the ability to move money from states that do not use all of their allocated funds to those states that need more, but right now the Obama administration has no plans to seek additional funding for the high-risk program.

How do I sign up?

Those who have been denied coverage because of preexisting conditions should visit the federal government’s health insurance Web portal at http://www.healthcare.gov. This site offers an online form that leads to links for application information specific for each state.


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