Pre-Existing Condition Insurance

This is a federal sponsored program specifically for those who cannot qualify for coverage because of a pre-existing condition

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This Insurance Plan is No Longer Available as of 03/02/2013

For more information about this plan closing click here

Pre-Existing Condition Insurance Plan (PCIP)

Pre-Existing Condition Insurance

This is a federal sponsored program specifically for those who cannot qualify for coverage because of a pre-existing condition. A pre-existing condition is a condition, injury or illness where you consulted a doctor or other licensed health practitioner and they diagnosed you, treated you or recommended treatment for you.

PCIP Qualifications:

• Must be a California resident.

• Must have a pre-existing condition confirmed by: A denial letter from a health insurance company within the last 12 months or A letter from a licensed doctor, physician assistant or other nurse practitioner stating you have or have had a medical condition or illness or received an offer of Individual coverage (not group coverage through an employer or other organization) with higher premiums than those offered by the Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) or A certificate of creditable coverage letter issued by another state or federally administered PCIP program showing prior enrollment within the past 6 months.

• Must not be enrolled in Medicare Part A or B, COBRA or Cal-COBRA.

• Must be a U.S. Citizen or U.S. National – or lawfully present in the U.S. A social security number will be required.

• Must not have had health insurance coverage for the last 6 months (if your prior coverage was a limited benefits policy, you could be eligible for PCIP. Call us at (800) 560-2443 for more details)

PCIP Benefits (assuming all in-network providers are used): 

(This is only a summary of benefits)

Annual Medical Deductible: $1,500
Out of Pocket Maximum (includes annual deductible): $2,500
Annual Benefit Maximum: None
Lifetime Benefit Maximum: None
Office Visits (not subject to deductible): $25 per visit
Inpatient or Outpatient Hospital (after annual deductible): 15% coinsurance
Brand Drug Deductible: $500
Mental Health Services: 15% coinsurance
X-Rays and Laboratory Services: 15% coinsurance
Alcohol & Substance Abuse Treatment: 15% coinsurance
Skilled Nursing Facility: 15% coinsurance
Pregnancy and Maternity Care: 15% coinsurance
Generic Prescription Drugs: $5 per drug
Brand Prescription Drugs (after $500 annual deductible): $15 per drug
Non-Preferred Brand or Specialty (after $500 deductible): $30 per drug
Preventive Services: $0
   *Cytology exams
   *Disease management programs
   *Family planning counseling services
   *Health Education Services
   *Hearing and eye tests for children
   *Immunizations for adults and children
   *Newborn blood tests
   *Prostate exams for men
   *Routine exams, mammograms, pap smears, human papillomavirus (HPV) tests, and ovarian     and cervical cancer screening for women Routine physicals and lab services
   *Tests for human Immunodeficiency Virus (HIV) and sexually transmitted infections
   *Well baby and well child care
   *Routine Colonoscopies

Click Here for a PCIP Application

Click Here for the entire PCIP Brochure (that includes application and price)

To apply, complete the application in its entirety and fax it to (310) 793-7757 or email completed application as an attachment to: Info@CaliforniaHealthInsuranceNow.com. Once we receive it, we will review it for any missing or incomplete information that could delay the processing. We will contact you by telephone once our review is complete (within 24 hours) with further mailing instructions. If you have any questions, please call us at (800) 560-2443.

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