California Pre-Existing Condition Insurance Plan (PCIP) 
Do you have a pre-existing conditionPATIENT FAQ 

The New Federal Healthcare Law includes health coverage for any person who is currently uninsured due to a denial for a pre-existing medical condition.  This new health insurance, called the Pre-Existing Condition Insurance Plan (PCIP), is available now and will remain in place until new health insurance options become available in January 2014.

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 if they have had a problem getting health insurance due to a pre-existing condition. 

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

  1. You are a California resident
  2. You have a pre-existing condition
  3. You are a US citizen or national, or lawfully present
  4. You are not enrolled in Medicare Part A and B, Cobra, Cal Cobra or no cost Medi-cal (Medicaid)
  5. You have not had health coverage for at least six months

How do I enroll?

Download the application at http://www.pcip.ca.gov/Downloads/. Complete the four-page application and mail to:

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

When will my PCIP coverage be effective?

Once the PCIP application is complete with all the required documentation and processed by the 15th of the month, coverage will begin the 1st day of the following month. For example:  If the applicant enrolled between 8/1/2010-8/15/2010, they are effective 9/1/2010.

How much does it cost me?**

Monthly premiums range from $107 to $557 per month depending on age and the region you live in within California.

What benefits do I receive under PCIP?

Covered In-Network Services:

  • $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 (ie. annual physicals), screening services (ie. cancer screenings, cardiac screenings, and mammograms), well-child care, and child and adult immunizations.

*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 family plans or premium levels in PCIP.

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