Who Can Qualify?
The PCIP eligibility requirements are:
- 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 22kb) from a licensed doctor, physician assistant, or nurse practitioner dated within the past twelve (12) months, stating that the individual has or had, a medical condition, disability, or illness, 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 81kb) 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 1,550kb) 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.
If you have questions on PCIP eligibility requirements, please give us a call at 1-877-428-5060, Monday - Friday, from 8 a.m. to 8 p.m. Or, on Saturday, from 8 a.m. to 5 p.m.
Who can be an applicant?
Any person of any age that meets the PCIP Eligibility requirements. The following individuals can be an applicant:
- Person 18 years of age or older who are applying for coverage himself/herself;
- Parents (natural or adoptive);
- Legal Guardians;
- Stepparents;
- Foster parents;
- Caretaker relatives for a minor;
- Minor not living with persons listed above (i.e. emancipated minor)
However, each individual applying for the PCIP must complete their own application, because the PCIP does not offer dependant coverage.
How do I apply for PCIP?
To apply for PCIP, you must complete the four-page PCIP/MRMIP Application (PDF 139kb).
Find out which program is right for you. The PCIP/MRMIP Worksheet (PDF 50kb) will help you understand if you could qualify and which program is better for you.
When you review the application, it is important that you carefully review the PCIP/MRMIP Handbook (PDF 1,550kb) which contains a Checklist. The Checklist explains the supporting documents and monthly premium you need to send with your application.
Mail the application, first month's premium and all necessary documents to:
Pre-Existing Condition Insurance Plan
P.O. Box 537032
Sacramento, CA 95853-7032
If you have questions when you fill out the applications, please give us a call at 1-877-428-5060, Monday - Friday, from 8 a.m. to 8 p.m. Or, on Saturday, from 8 a.m. to 5 p.m.
Important Notice:
If you are currently or will be enrolled in the MRMIP, you will not qualify for the PCIP. The PCIP requires that an individual not have health insurance coverage for at least 6 months.
What documents must I send when applying for PCIP?
Your PCIP/MRMIP Application must contain the following:
- A personal check, cashier's check or money order for one month’s premium payable to the Managed Risk Medical Insurance Board (MRMIB) in the amount for the program you prefer on the PCIP/MRMIP Application, question #2.
Your monthly PCIP premiums are based on your age and where you live. Your monthly MRMIP premiums are based on your age, where you live, and number of dependent(s), if any. Click here for PCIP and MRMIP Monthly Premiums (PDF81kb) (I.e. just applying for yourself - PCIP, yourself plus dependent - MRMIP).
- You must have been denied individual insurance coverage within the past 12 months, for a pre-existing condition as shown by:
- A denial letter from a health insurance company or health plan in the last 12 months, or
- A letter (PDF 22kb) from a licensed doctor, physician assistant, or nurse practitioner dated within the past twelve (12) months, stating that the individual has or had, a medical condition, disability, or illness, or
- An offer of individual (not group) health coverage at higher premiums higher than those the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) rate where you live. See MRMIP PPO monthly premiums (PDF 81kb) 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's or Federally administered PCIP program showing previous enrollment within the past 6 months (see page 20 of the PCIP/MRMIP Handbook (PDF 1,550kb) for more details
- Proof of U.S. Citizen/U.S. National as shown by:
- U.S. Passport;
- Birth certificate;
- Naturalization/Citizenship certificate;
- American Indian or Alaska Native enrollment document from a federally recognized tribe;
- A Certificate of Degree of Indian Blood (CDIB) from the Bureau of Indian Affairs; or
- A letter of Indian Heritage from a California Indian Health Service Clinic.
- Proof of Lawful residency by sending copies of unexpired immigration documents. Please make sure the document shows the expiration date and is not expired. Send copies of the front and back sides.
| Legally Residing Individuals Status | Acceptable Documentation: |
|---|---|
| Permanent Resident | INS Form I-551 or stamp |
| INS Form I-94 w/203(a)7 stamp | |
| INS Form 797 showing I-360 filing | |
| EMP-AUTH-CARD | |
| EMP-AUTH-DOC | |
| Green card | |
| Conditional Entry | INS Form 688b |
| INS Form I-94 w/203(a)7 stamp | |
| EMP-AUTH-CARD | |
| EMP-AUTH-DOC | |
| Paroled into U.S. | INS Form I-94 w/203(a)7 stamp |
| Immigration Judge Notice/Court Order | |
| Violence Against Women/Children Act | INS Form 688b |
| INS Form I-551 or stamp | |
| INS Form I-94 | |
| Immigration Judge Notice/Court Order | |
| INS Form 130 | |
| INS Form 797 showing I-360 filing | |
| Asylum | INS Form 688b |
| INS Form I-94 | |
| Immigration Judge Notice/Court Order | |
| INS Form 766 | |
| Asylum Grant Letter | |
| Refugee | INS Form 688b |
| INS Form I-551 or stamp | |
| INS Form I-94 | |
| INS Form I-571 Refugee Travel Document | |
| INS Form 766 | |
| Deportation Withheld under Court Order | INS Form 688b |
| Immigration Judge Notice/Court Order | |
| INS Form 766 | |
| Cuban/Haitian Entrant | INS Form I-551 or stamp |
| INS Form I-94 | |
| Veteran or Active Duty Military | DD Form 214 – Military Discharge |
| Military ID Card | |
| Current Military Orders | |
| Dependant Military ID | |
| Spouse or Dependant of Vet/Military | Dependant Military ID |
| Amerasian Immigrant | INS Form I-551 or stamp |
| INS Form I-94 | |
| Citizens of a Compact of Free Association State | INS Form I-94 or INS I-94A |
| Individuals without Permanent Residence in their Country Permitted to remain in the US indefinitely a) Temporary Resident Status b) Temporary protected Status c) Family Unity Beneficiaries |
INS Form I-94 |
| INS Form I-821 | |
| INS Form I-817 | |
| Non U.S. Immigrants Indefinitely a) Parents or children of individuals with special immigrant status b) Fiancées of a citizen c) Religious workers d) Individuals assisting the Department of Justice in a criminal investigation e) Battered aliens f) Individuals with a petition pending for 3 years or more |
INS Form I-360 |
| INS Form I-129F, K-1 Visa | |
| INS Form I-129 | |
INS Form I-94, E1-E2 Visa |
|
| INS Form I-140 |