California State Sponsored or Administered Health Coverage
The state of California offers specialty programs and/or assistance programs to those who do not qualify for health insurance due to preexisting conditions or income restrictions, and for small employers of 2 to 50 workers. Contact information for each of the programs is available in the resources section of this brochure.
Major Risk Medical Insurance Program (MRMIP)
The Major Risk Medical Insurance Program (MRMIP) offers limited health insurance benefits to California residents who are unable to purchase health insurance due to a preexisting medical condition. If you have a preexisting condition and are not eligible for COBRA, Cal-COBRA, or HIPAA, then you can apply to MRMIP as a last resort to obtain health coverage. This program provides health care coverage through contracted health insurance companies and health plans. MRMIP is partially subsidized; however, qualifying participants must pay a portion of the premium, which can be costly. Since there are few options for the medically uninsurable in California, the waiting list for MRMIP can be long. MRMIP is under the jurisdiction of the Managed Risk Medical Insurance Board (MRMIB).
Recent legislation has created a 36-month limit for participation in MRMIP. At the end of this period, MRMIP enrollees are given a one-time opportunity to purchase guaranteed issue health coverage through any indemnity policy, PPO, or HMO currently offering individual health coverage in California. Eligible MRMIP participants who are "disenrolling" after the 36-month period have 63 days to apply for individual health coverage. Ninety days prior to the disenrollment, MRMIP participants receive a notice of disenrollment and 45 days prior to disenrollment, participants are mailed a Certificate of Program Completion that enables them to obtain individual health coverage.
All indemnity insurance companies, PPOs, and HMOs who offer comprehensive individual medical coverage in California are required to offer a Standard Benefit Plan that is substantially the same as the health coverage offered while on MRMIP. These Standard Benefit Plans are the only health coverage required to be offered on a guaranteed issue basis and are separate from other individual health coverage that is available in the marketplace. If you have questions on the Standard Benefit Plans that are being offered, contact the CDI or the DMHC depending upon the type of individual coverage you want to elect (indemnity or HMO).
Healthy Families Program
Originally designed to protect children of low income parents, the Healthy Families Program provides low cost health, dental, and vision coverage to children whose parents earn too much to qualify for public assistance, but do not earn enough to purchase comprehensive major medical coverage for their children. The Healthy Families Program is administered by MRMIP. There is a current proposal to expand the Healthy Families Program to include the parents of eligible children through special federal funding.
Access for Infants and Mothers Program (AIM)
In an effort to expand prenatal and preventive care for pregnant women, California established the Access for Infants and Mothers Program (AIM). AIM is administered by a five-person board that has established a comprehensive benefits package that includes both inpatient and outpatient care for program enrollees. Pregnant women of low to moderate income are eligible for the program and participate in the cost of health care services by paying a reduced premium. The state of California subsidizes AIM to make up for the full cost of the program benefits.
Pacific Health Advantage (PacAdvantage)
The state of California sponsors Pacific Health Advantage (PacAdvantage) to help provide more affordable health insurance coverage to small employers between 2-50 workers. PacAdvantage pools the purchasing power of participating small employers allowing for a variety of standard health benefit plans to be offered at more favorable rates. Health plan rates vary by age, family size, and region. Employees may choose among a number of health, dental, vision, chiropractic, and acupuncture plans.
Supplemental Health Insurance Policies
Most supplemental health insurance policies are designed to pay in addition to your comprehensive major medical coverage. These supplemental policies should not be used as a substitute or replacement for a traditional health insurance policy or a health plan. Supplemental health insurance can pay limited benefits such as a daily dollar amount if you are hospitalized (hospital income policy) or a lump sum dollar amount if you are diagnosed with a specified or named disease, such as cancer. This type of supplemental policy can also be structured to pay expenses incurred in the treatment of the specified disease. Sometimes this insurance provides payment over and above your medical expenses. It is important that you understand the limitations and exclusions of supplemental health insurance policies and how the policies coordinate benefits, so that you can make the best decision based on your needs and your budget.
