California Pre-Existing Condition Insurance Plan (PCIP)

What is the Pre-Existing Condition Insurance Plan?

The Pre-Existing Condition Insurance Plan was created as part of the nation's new health insurance law, the Affordable Care Act, to make health insurance available to people who have problems getting health insurance due to a pre-existing condition. 

How do I know if I am eligible for coverage through PCIP?*

Eligible individuals must:

• Be a California resident
• Be a U.S. citizen or a legal resident  (U.S. citizens or U.S. nationals must provide a Social Security number)
• Have been uninsured for at least the last six months before applying for coverage (proof of denial from insurance company will be needed)
• Have a pre-existing medical condition and not have been covered under health coverage for the previous 12 months, or have been offered individual health insurance coverage at a premium rates higher than the California Major Risk Medical Insurance Program (MRMIP) preferred provider organization (PPO) within the last 12 months.

How do I enroll?

Complete both the PCIP Supplemental Application and the Major Risk Medical Insurance Program (MRMIP) Application and mail to:

Pre-Existing Condition Insurance Plan
P.O. Box 537032
Sacramento, CA 95853-7032

When will my PCIP coverage be effective?

If your PCIP application has all the required documentation and is processed by the 10th of the month, coverage will begin the first day of the following month. For example: If a typical applicant enrolled between August 1 and August 10, that person’s coverage would be effective on September 1.

How much does it cost me?**

Monthly premiums range from $127 to $1,003 per month, depending on age and the region you live in within California.

What benefits do I receive under PCIP?

In-network coverage includes:

• $1,500 annual deductible (except for preventive services, which have no copay or deductible)
• Patient pays 15% of the cost of covered benefits
• Preventive services include periodic health evaluations (annual physicals), screening services (mammograms and cancer and cardiac screenings), well-child care and immunizations for children and adults

* Persons currently covered by a health plan — including employer insurance plans, Medicare, Medicaid and existing high-risk pool programs — are not eligible for the Pre-Existing Coverage Insurance Plan. PCIP coverage is only available to an eligible individual. There are no PCIP family plans or premium levels.

** Premiums may be subject to changes made by PCIP.