California’s Pre-Existing Condition Insurance Plan (PCIP) Transitions to Federal PCIP Program on July 1, 2013.
Beginning July 1, 2013, California will no longer operate the state’s PCIP program. Subscribers will be transitioned to the federally-run PCIP. The CA PCIP will send out a notification letter in May to provide subscribers with instructions. In June, the National Finance Center, the enrollment administrator for the federally-run PCIP, will send out an Enrollment Letter that includes information about the federally-run PCIP plan, how much it costs, and how to activate coverage. Subscribers will not need to complete a new application to qualify for the federally-run PCIP. To activate their new coverage on July 1, and receive their PCIP ID cards by that date, subscribers must pay their first month’s premium by the deadline stated in that letter.
If a subscriber is in the course of treatment or has received prior-authorization for services, he or she will be mailed guidance about transition of care. It is critical that he or she follow required pre-authorization of benefits procedures for hospitalization, durable medical equipment or supplies, transplants, skilled nursing, long-term acute care or rehabilitation facility admission, spinal fusion surgery or cancer treatment plans anticipated to occur on or after July 1. This is necessary even if the subscriber was already authorized with the California PCIP.
For more information on the federally run PCIP, you can go to www.pcip.gov or call 866-717-5826 Monday-Friday 5:00 am to 8:00 pm (TTY: 1-866-561-1604).
If the June premium for California PCIP has not been paid by May 30, 2013, the subscriber will be disenrolled before the PCIP transition. If subscribers have already pre-paid their July premium for California PCIP, any credits on the account will be refunded. If the subscriber has a recurring credit card payment or an automatic electronic fund transfer to the California PCIP, we will discontinue those recurring payment draws from the account. Premiums paid to the California PCIP, including pre-paid premiums for future months, cannot be applied toward premiums for the federally-run PCIP program.
If you have questions about the existing California PCIP, you can call 1-877-428-5060 (Monday through Friday 8:00 am to 8:00 pm, Saturday 8:00 am to 5:00 pm) or go to www.pcip.ca.gov.