Guaranteed Health Insurance in California

High Risk Medical Insurance is Available Through the MRMIP

Aug 17, 2009 John Wu

California's Major Risk Medical Insurance Program (MRMIP) provides health insurance for Californians who cannot get health insurance from any other source.

For those in California without employer sponsored group health insurance, there is no guarantee that an individual can secure coverage in the private marketplace. Insurers will either significantly increase premiums or deny coverage altogether for those who have major medical conditions such as cancer or HIV. However, the MRMIP provides heath insurance coverage for Californians who have no other option.

The MRMIP is a California state run program that manages guarantee issue health insurance for residents that have no other health insurance option. The policies are issued by several insurance companies. Subscribers pay for the policy through premiums, deductibles, and co-payments which vary depending on the plan chosen and zip code of the subscriber.

Establishing Eligibility for MRMIP

In order to secure coverage, the applicant for MRMIP needs to meet one of the following four requirements:

• Denied individual health insurance in the last 12 months.
• Involuntarily terminated from health coverage for a reason other than fraud or non-payment of premium within the last 12 months.
• Offered health insurance with a premium higher than the applicant's health plan selection.
• Currently not eligible, but anticipates being eligible in the future.

The best way to establish eligibility for the program is to apply for individual health coverage and furnish a copy of the denial letter with the MRMIP application.

In addition, there are a few other requirements that need to be met:

• California residency
• Not eligible for Medicare Part A and Part B unless eligible solely due to end stage renal disease
• Not eligible for COBRA or Cal-COBRA coverage

There are no medical exams required for coverage. However, coverage for pre-existing conditions may be limited.

MRMIP PPO Limitations

For those who pick a PPO, there is no coverage for pre-existing conditions for up to 90 days. A pre-existing condition is one in which medical advice, care, diagnosis or drugs were given during the six months before MRMIP enrollment. Previous medical insurance coverage may be used to shorten or eliminate the pre-existing condition limitation.

MRMIP HMO Limitations

HMO participants have to wait up to 90 days before coverage begins. Healthy customers with no pre-existing medical conditions are subject to the 90 day waiting period since the waiting period does not consider an applicant's health. Premiums do not need to be paid during the waiting period. Just like with the PPO option, previous insurance coverage can be used to shorten or eliminate the waiting period.

Deductible and Maximum Medical Benefits

All MRMIP plans have a deductible of $500. The types of expenses that count towards the deductible vary from plan to plan.

A maximum of $75,000 in benefits per year with a $750,000 lifetime maximum is allowed for all MRMIP policies. Those with expensive medical conditions such as some forms of cancer should consider alternative medical coverage. For example, aggressive treatment of stage 4 colon cancer could cost well over $200,000.

The program is not right for everyone due to limited benefits and relatively high premium costs. Some may want to consider no exam health insurance, Medicare, or Medicaid (called Medi-Cal in California) instead. However, those who have no other medical coverage options should seriously consider enrolling in the program.

References:

California Managed Risk Medical Insurance Board ( MRMIB )

The copyright of the article Guaranteed Health Insurance in California in Insurance is owned by John Wu. Permission to republish Guaranteed Health Insurance in California in print or online must be granted by the author in writing.

MRMIP California Guarantee Issue Health Insurance