California Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Major Risk Medical Insurance Program/ MRMIP
Insurance Regulation Establishing Risk Pool
California Assembly
Assembly Bill No. 1401 Amends Original MRMIP Legislation
Funding
Funds to operate MRMIP come partially from premium payments made by plan members. The deficit incurred by the pool is subsidized through the Cigarette and Tobacco Surtax Fund established under Proposition 99.
Plans Offered
Health insurance coverage under the MRMIP is available for a maximum of 36 months. There is an HMO plan option available, as well as a PPO plan. The PPO plan is the Blue Cross of California Preferred PPO plan and is administered by Blue Cross of California. The HMO plan is available through various insurance companies, including Blue Shield of California, Contra Costa Health Plan, and Kaiser Permanente. After the 36 months of MRMIP enrollment, guaranteed issue coverage is available through these same insurance companies at a slightly higher monthly premium.
Plan Benefits
The Blue Cross of California Preferred PPO plan has no deductible and a 15% coinsurance for many covered medical expenses. Office visits are provided at a $25 co-payment and there is no deductible for prescription drugs. The annual co-payment maximum on this PPO plan is $2,500. The Blue Shield of California Access + and the Contra Costa Health Plan HMO's both offer a $15 office visit co-payment and a $200 per day hospitalization co-payment. The HMO Plan offered through Kaiser Permanente has a $20 office visit co-pay.
Maximum Benefit Limits
All plans offered through MRMIP plan have an annual maximum benefit of $75,000 and a lifetime benefit of $750,000.
Eligibility
- Must be a resident of California
- Cannot be eligible for Medicare Part A and Part B unless you are on Medicare for end-stage renal disease
- You must be ineligible to purchase health insurance under COBRA or CalCOBRA
- You must not be able to obtain other adequate health insurance, which must be verified by; a) a letter of denial from an insurance company within the past 12 months, b) a letter proving that you were involuntarily terminated from another health plan within the past 12 months, or c) proof that you have been offered other individual health insurance at a higher premium than those available to you through MRMIP
Enrollment Periods
California is one of the few states that place a cap on enrollment in their health insurance risk pool. Prior to the implementation of the Guaranteed Issue Pilot Program, there was a lengthy waiting list to get on to the MRMIP program. GIP reduced the maximum length of enrollment to 36 months, thus opening the plan to new members by requiring current members to leave the plan. A limited number of new members are permitted on the plan, but there are no restrictions on when you can apply for coverage.
Premium Payments
Premiums are based on your plan selection, your age and your county of residence. Premium payments are made in advance of the month of coverage and are due on the first of the month. There is a 31 day grace period for payment before your policy can be cancelled for non-payment of premium.
Premium Calculations
Monthly premiums are determined by looking at the standard risk premiums available for plans of similar benefit levels available to healthy individuals in California. MRMIP plan premiums may not be higher than 137.5% of the standard risk, and no lower than 125% of this same standard rate.
Pre-Existing Condition Waiting Periods
MRMIP members enrolled in a PPO plan have a 3 month pre-existing condition exclusionary period. During this period, no benefits are paid toward any medical treatments or medications associated with this pre-existing condition. If you enroll on a HMO plan, there is a post-enrollment waiting period of 3 months in which members will not be eligible for health care services. The exclusionary period may be waived if, a) you were on the MRMIP waiting list for longer than 180 days, b) you were enrolled in another health insurance plan within 63 days of your enrollment in MRMIP and that previous coverage was in effect for at least 3 months, c) you lost your group health insurance policy and enrolled in MRMIP within 180 days of losing coverage, or d) you were on a similar high risk pool health insurance plan in another state within the past 12 months.
California Major Risk Medical Insurance Program Contact Information
Managed Risk Medical Insurance Board
1000 G Street, Suite 450
Sacramento, CA 95814
Phone: 916-324-4695
Fax: 916-324-4878
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