About PCIP
What Is PCIP?
The Pre-Existing Condition Insurance Plan (PCIP) is a program that offers health coverage to medically-uninsurable individuals who live in California. As a result of the federal health care reform, California now offers a federally-funded health coverage program called PCIP. This program is available for individuals who did not have health coverage in the last 6 months.
In order for a person to qualify for the PCIP, a person must have met the following eligibility requirements:
- You are a resident of California.
- You have a pre-existing condition as shown by:
- A denial letter from a health insurance company or health plan dated within the last 12 months, or
- A letter (PDF 113kb) dated within the last 12 months, from a licensed doctor, physician assistant, or nurse practitioner, stating the individual has or used to have a medical condition, disability, or illness (go to PCIP website for a sample form), or
- An offer of individual (not group) health coverage with higher premiums than the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) rate in the area where you live. See MRMIP PPO monthly premiums (PDF 399kb) page 8 - 13 of the PCIP/MRMIP Handbook. The offer letter must be dated within the last 12 months, or
- A certificate of creditable coverage letter issued by another state or Federally administered PCIP program showing previous enrollment within the past 6 months (see page 20 of the PCIP/MRMIP Handbook (PDF 1,089kb) for more details).
- You are not enrolled in Medicare Part A and B, COBRA, or Cal-COBRA benefits.
- You are a U.S. Citizen or U.S. National – or you are lawfully
present in the U.S. (you must provide a Social Security Number if you are a U.S. Citizen or U.S. National). - You have not had health coverage for at least 6 months.