California will open a new high-risk health insurance plan in September for people who have medical conditions that make it difficult, if not impossible, to obtain coverage.
The plan will be one of the first major results of the national health reform law. With $761 million in federal funding, it is expected to provide coverage for 20,000 to 25,000 Californians.
People can begin submitting applications this month, state officials have announced.
"For those who have no other option in the private marketplace, this is a huge benefit," said Anthony Wright, executive director of Health Access California, a consumer advocacy group. "They will be able to get coverage that is crucial for them and their family."
The goal is to assist people who have been denied coverage or quoted exorbitant rates because of a host of medical issues ranging from serious diseases to such common conditions as asthma, sleep apnea, allergies, migraine headaches and even toenail fungus.
Thousands of Californians nervously live without insurance, hoping to avoid a severe illness or injury that could push them over the edge financially.
The Pre-existing Condition Insurance Plan will operate until 2014. At that point, the federal health reform law will ban insurers from rejecting people or charging higher rates based on medical conditions.
California is one of 28 states that have decided to set up their own high-risk plans. Other states will
offer a program provided by the federal government.
California has operated another high-risk plan for many years, but it has minimal funding and rates that are too costly for many people. It limits benefits to $75,000 annually and $750,000 for a lifetime. No more than 7,100 people can participate.
The new plan will have no limits on annual or lifetime benefits. It also will have substantially lower premiums than the existing plan in many cases, although it may still be pricey for some people.
A sampling of the new plan's rates reveals that 15- to 29-year-olds in Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara counties will have monthly premiums of $201.
People ages 45 to 49 will pay $377 per month. Those age 60 to 64 will pay $802, compared with $1,233 for the Anthem PPO under the existing plan.
But those in the existing plan who want to switch to the new plan will be out of luck. The federal health reform law requires that participants in the new high-risk pools have been uninsured for at least six months.
So California will continue to operate both plans until 2014.
Participants in the new California plan also must be a citizen or lawful resident of the United States, and must have been denied coverage by an insurance company within the past 12 months or offered coverage at rates above those in the existing high-risk pool.
How many people will be interested in the new plan remains to be seen. But to date, nearly 4,000 have requested applications.
Wright noted that there should be enough money to quadruple the number of participants compared with the existing plan.
"We think there will be additional demand that will go beyond even this increased funding," he said. "But this is a clear step up from the current program. We recognize that it's a bridge to a system that's better in 2014."
To receive an application for the state's Pre-existing Condition Insurance Plan, which will open in September, people can call 916-324-4695 or send an e-mail with their name, address, phone number and e-mail address to email@example.com.
Details are available at www.mrmib.ca.gov.
# To be eligible, you must: Be a citizen, national or lawful resident of the United States.
# Have had no health insurance during the past six months.
# Have a pre-existing medical condition, including proof of denial by an insurance company within the past 12 months, or an offer of coverage with premiums higher than those in the state's existing high-risk plan.
Here are the premiums for the new plan in Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara counties:
By the numbers
Age Monthly premium
Younger than 15 $140
Older than 74 $1,003
Source: Managed Risk Medical Insurance Board
By Sandy Kleffman
Contra Costa Times