David Fluker Insurance Services
Gilroy, California - Serving California Residents Since 1995
California License 0B58920
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David J. Fluker, Licensed Life & Health Insurance Agent. California State License # 0B58920
Authorized Independent Agent Serving California Residents.
Web Site ©1999 by David Fluker - David Fluker Insurance Services. All Rights Reserved.
Authorized Independent Agent Serving California Residents.
Web Site ©1999 by David Fluker - David Fluker Insurance Services. All Rights Reserved.
Anthem Blue Cross is an independent licensee of the Blue Cross Association (BCA). The Blue Cross name and symbol are registered service marks of the BCA.
Blue Shield of California Life & Health Insurance Company is an independent licensee of the Blue Shield Association.
Blue Shield of California Life & Health Insurance Company is an independent licensee of the Blue Shield Association.
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California MRMIP and PCIP Risk Pools for Health Insurance
Note: Federal PCIP Program has suspended new enrollments effective 2/16/13. California PCIP has now officially announced the suspension of all new enrollments after March 2, 2013. Applications for CA PCIP submitted or received after March 2, 2013 will be vetted for MRMIP only, no new enrollments in the PCIP. PCIP ran out of money. Existing PCIP members will not be effected.
The California MRMIB (Major Risk Medical Insurance Board) is currently tasked with the operation of two separate, yet related risk programs. Both programs provide health insurance coverage to those California residents who are unable to obtain private individual coverage due to medical conditions and who are not eligible for state/federal coverage (Medi-Cal/Medicare) nor employer-sponsored coverage.
What Are The Differences Between MRMIP (Major Risk Medical Insurance Program) and PCIP (Pre-existing Condition Insurance Program).
MRMIP is California's state risk program for health insurance. Funded primarily with tobacco taxes, the MRMIP is a small pool of approximately 7,100 available subscriber slots. The pool may have enrollment waiting periods (waiting list) depending on enrollment population. MRMIP does not require any specific period of being uninsured in order to apply and enroll. The program does impose a pre-existing condition waiting period on some plans of three months, which will be waived if an applicant has been on the waiting list for six months or more. MRMIP currently offers one plan each from Anthem Blue Cross (PPO), Kaiser Permanente and Contra Costa Health (for residents of Contra Costa County only). Benefits are limited on MRMIP--$75,000 per year maximum benefit and $750,000 lifetime maximum benefit. Rates can be very high for MRMIP and the provider network is usually limited to the Medi-Cal provider network for each carrier. Requirements to enroll include residency requirements, inability to obtain private insurance (declined by an insurance carrier) and not eligible for any other type of health insurance coverage (Medi-Cal, Medicare, employer-sponsored).
PCIP is California's temporary federal risk program for health insurance. Provided under the PPACA (Patient Protection and Affordable Care Act, also known as ObamaCare), PCIP was set up in California to be funded with federal dollars ($761 Million) and operated by the state MRMIB alongside but separate from the MRMIP. Current PCIP is a larger pool offering up to 23,100 subscriber slots. Unlike MRMIP, PCIP requires similar residency and uninsurability status, but requires that any applicant must have been uninsured for at least six months before enrolling in the PCIP. PCIP has no annual benefit maximum, no lifetime maximum benefit and is priced substantially below the MRMIP pricing guideline. PCIP uses the Blue Shield CA PPO network and offers one, unified PPO plan not designated to any specific insurance carrier. PCIP is intended to terminate in 2014 in favor of the PPACA-direct California Health Insurance Exchange. One note, there is a second round of funding for the CA PCIP in 2012 if the pool is at maximum capacity before then. This could potentially increase the overall slots to around 46,000 for the remaining years of 2013 and 2014.
How Do I Enroll In MRMIP And PCIP?
New unified MRMIP-PCIP application available below.
In order to apply for the PCIP or MRMIP, an applicant previously had to complete two separate applications – one for PCIP and one for MRMIP. The Managed Risk Medical Insurance Board (MRMIB), the state agency that administers both programs, has created a new application to be used when applying for the programs. The new application and handbook, referred to as the PCIP/MRMIP Application and Handbook, consolidates the PCIP Supplemental and the MRMIP Applications into one single application form and handbook.
To apply for PCIP or MRMIP, applicants will only need to complete the PCIP/MRMIP application to apply for either program. All applications received are reviewed for both health care programs; however, an applicant can simply check a box for their preferred health care program choice. If a preference is not selected and an applicant qualifies for both PCIP and MRMIP, they will be enrolled in PCIP.
MRMIP is a state health care program for medically uninsurable Californians that has different eligibility rules, annual deductibles, annual lifetime caps and monthly premium costs compared to PCIP. If an applicant is enrolled in MRMIP, when applying for PCIP they will not meet the requirement of not having health care coverage for at least six months prior to submitting their application for PCIP.
Unified PCIP/MRMIP Application and Handbook (2013) Be sure to mail back to me so that I can sign off on the agent section and submit on your behalf.
MRMIP Anthem Program Request Form (use this form to generate a denial from Anthem Blue Cross without having to submit a full underwritten application)
What Are The Differences Between MRMIP (Major Risk Medical Insurance Program) and PCIP (Pre-existing Condition Insurance Program).
MRMIP is California's state risk program for health insurance. Funded primarily with tobacco taxes, the MRMIP is a small pool of approximately 7,100 available subscriber slots. The pool may have enrollment waiting periods (waiting list) depending on enrollment population. MRMIP does not require any specific period of being uninsured in order to apply and enroll. The program does impose a pre-existing condition waiting period on some plans of three months, which will be waived if an applicant has been on the waiting list for six months or more. MRMIP currently offers one plan each from Anthem Blue Cross (PPO), Kaiser Permanente and Contra Costa Health (for residents of Contra Costa County only). Benefits are limited on MRMIP--$75,000 per year maximum benefit and $750,000 lifetime maximum benefit. Rates can be very high for MRMIP and the provider network is usually limited to the Medi-Cal provider network for each carrier. Requirements to enroll include residency requirements, inability to obtain private insurance (declined by an insurance carrier) and not eligible for any other type of health insurance coverage (Medi-Cal, Medicare, employer-sponsored).
PCIP is California's temporary federal risk program for health insurance. Provided under the PPACA (Patient Protection and Affordable Care Act, also known as ObamaCare), PCIP was set up in California to be funded with federal dollars ($761 Million) and operated by the state MRMIB alongside but separate from the MRMIP. Current PCIP is a larger pool offering up to 23,100 subscriber slots. Unlike MRMIP, PCIP requires similar residency and uninsurability status, but requires that any applicant must have been uninsured for at least six months before enrolling in the PCIP. PCIP has no annual benefit maximum, no lifetime maximum benefit and is priced substantially below the MRMIP pricing guideline. PCIP uses the Blue Shield CA PPO network and offers one, unified PPO plan not designated to any specific insurance carrier. PCIP is intended to terminate in 2014 in favor of the PPACA-direct California Health Insurance Exchange. One note, there is a second round of funding for the CA PCIP in 2012 if the pool is at maximum capacity before then. This could potentially increase the overall slots to around 46,000 for the remaining years of 2013 and 2014.
How Do I Enroll In MRMIP And PCIP?
New unified MRMIP-PCIP application available below.
In order to apply for the PCIP or MRMIP, an applicant previously had to complete two separate applications – one for PCIP and one for MRMIP. The Managed Risk Medical Insurance Board (MRMIB), the state agency that administers both programs, has created a new application to be used when applying for the programs. The new application and handbook, referred to as the PCIP/MRMIP Application and Handbook, consolidates the PCIP Supplemental and the MRMIP Applications into one single application form and handbook.
To apply for PCIP or MRMIP, applicants will only need to complete the PCIP/MRMIP application to apply for either program. All applications received are reviewed for both health care programs; however, an applicant can simply check a box for their preferred health care program choice. If a preference is not selected and an applicant qualifies for both PCIP and MRMIP, they will be enrolled in PCIP.
MRMIP is a state health care program for medically uninsurable Californians that has different eligibility rules, annual deductibles, annual lifetime caps and monthly premium costs compared to PCIP. If an applicant is enrolled in MRMIP, when applying for PCIP they will not meet the requirement of not having health care coverage for at least six months prior to submitting their application for PCIP.
Unified PCIP/MRMIP Application and Handbook (2013) Be sure to mail back to me so that I can sign off on the agent section and submit on your behalf.
MRMIP Anthem Program Request Form (use this form to generate a denial from Anthem Blue Cross without having to submit a full underwritten application)
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