The Pre-existing Condition Insurance Plan is a federal program that offers health coverage to medically-uninsurable individuals who live in California. This federally-funded health coverage program is the result of federal health care reform and is meant to help individuals who are unable to obtain traditional, individual health insurance due to a pre-existing condition.
To qualify for the PCIP, a person must:
- Be a California resident
- Have no health insurance coverage for the past 6 months prior to application date
- Be a U.S. Citizen, U.S. National, or lawfully present individual
- Provide a social security number
- Have been denied individual insurance coverage within the past 12 months, for a pre-existing condition shown by:
- A rejection letter from a health insurance company in the last 12 month, or
- Offered coverage with premiums higher than those of the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) in the geographic region where the individual is seeking coverage.
The pros of the PCIP are that the plan covers individuals who would otherwise be unable to obtain health insurance coverage and that a wide range of individuals may apply. Both adults and minors are eligible for the plan.
Another pro of the PCIP is that although there is only one provider network, that network is a PPO network with health providers in all 58 counties of the state.
A major con to the PCIP is that to qualify, individuals must not have had health coverage in the 6 months prior to applying. This means that individuals wanting to enroll in the PCIP must have a lapse in coverage of at least 6 months.
Another con of the PCIP is that there is no dental or vision coverage included. If an individual needs this coverage, he or she must obtain it separately.
The final con of the PCIP is that there is an annual deductible of $1,500 for services and $500 for prescriptions.