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California Health Insurance Pool

About California Risk Pool

Name of Risk Pool: Major Risk Medical Insurance Program (MRMIP)

Californian residents need not worry about their health issues anymore as Major Risk Medical Insurance Program covers the most difficult of medical issues. You may not find some of the insurance companies covering all the ailments.

People with pre-existing medical issues can be covered by MRMIP. A resident of California is eligible for the MRMIP, only if they are not covered under COBRA, CalCOBRA, Medicaid and HIPAA. The person will be insured only if his/her latest policy has not been terminated due to non-payment issues or in case of fraud.

People covered under Health Coverage Tax Credit program or eligible under HIPAA group plans are not covered by Major Risk Medical Program.

California Risk Pool Plans:

The plan is offered for a period of 36 months. Two main plans are offered by this risk pool, namely HMO and PPO. The Anthem Blue Cross of California has recognised the HMO plan. Kaiser Permanente, Blue Shield of California, and Contra Costa Health Plan are the insurance companies, which have recognised the HMO plan. 36 months following MRMIP the insured gets the coverage.

Funding the Risk Pool:

MRMIP is funded by the premiums. The Cigarette and Tobacco Surtax Fund however, reduce the deficit amount.

Advantages of California Risk Pool:

PPO plan by Anthem Blue Cross of California has an annual deductible of 500 dollars with 15 percent coinsurance covering several other medical expenditures. No extra deductible is acquired for prescribed drugs. After reaching the maximum limit of copayment, the company pays 100 percent of the expenses for the year.

The insurance cover is covered under the Blue Shield Access along with HMO plan, which is provided to MRMIP insurers in some of the counties. Along with HMO Contra Costa Health Plan, the Blue Shield of California Access offers 200 dollars for per day hospitalization and 15 dollars office visit copayment.

Eligibility Criteria for California Risk Pool:

  • Has to be a Californian resident.
  • The insurer must not be covered under Medical Part B and Part A for renal medical problem.
  • The insurer must not be under the CalCOBRA or COBRA
  • The insurer cannot get a health insurance cover before the previous year. This however, needs to be verified by the insurance company that clears the charges of fraud or involuntary termination of the insured from the previous policy held.

Enrolling for California Health Pool Programs:

Enrolling for a California Health Pool program doesn't come easy. On reaching the maximum limit of enrolment, the user is kept on hold. There are funding limits in California for such plans. Before Guaranteed Issue Pilot Program, there used to be a prolonged process for enrolling into the MRMIP plan. This period was reduced to 36 months by the GIP. This led to attracting new members and shifting the existing ones to other plans by private health insurance company. The plan permits a limited number of people. Apart from this, there is no other restriction.

While on hold, the user can opt for other similar plans to MRMIP from Blue Shield of California or Anthem Blue Cross of California. As such plans are unsubsidized; the rates may be higher compared to MRMIP programs.

Premiums for MRMIP:

Premiums are decided on the kind of the plans, duration, country and other such factors. These are collected in advance. There is a grace period for the payment before the plan is terminated for non-payment issues.

The premiums are calculated by considering the standard risk for such plans available for individuals in California. The MRMIP is not more than 137.5 percent of the risk rate and lesser than 125 percent of the same standardised rate.

Waiting Period for MRMIP:

There is a 3 month long waiting time for PRO Plan. During this time, no benefits associated with this plan are provided to the insured. Before taking up the HMO plan however, there is an enrolment period waiting for 3 months after the plan is taken. During this period also the insured may not get the benefits of the plan for his/her healthcare. The conditions are waved off under following conditions:

  1. Previous insurance cover was active for 3 months
  2. There was a waiting period of 180 days before the MRMIP plan
  3. The insured has enrolled for another plan that has an enrolment period of 63 days
  4. Group Health Insurance was lost and was replaced by MRMIP within the time gap of 180 days.
  5. The insured had similar risk pool coverage in a different state within the previous year.

To know more about the insurance plan, check out

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