California MRMIP: How To Get There From Here

I wanted to post about a relatively new enrollment process with regard to the California MRMIP (Major Risk Medical Insurance Program). Mainly I want to advise people interested in enrolling in MRMIP to be sure and submit paperwork well ahead of the desired start date.

Until recently, California residents wishing to enroll in the Major Risk Program (MRMIP) or the temporary PCIP (Pre-Existing Conditions Insurance Program) could choose which program they wished to enroll into based on qualifications and eligibility requirements. At one time there was a separate application form and enrollment guide for each of the Risk programs.

Currently, the PCIP handles all enrollment processing for both PCIP and MRMIP in Folsom. Using the newer, unified application form, applicants must submit the paperwork first to PCIP for initial processing. Even if you choose the MRMIP and have no interest nor eligibility for PCIP, the PCIP folks must first determine that you are, in fact, not eligible for PCIP before they will forward the paperwork down to MRMIP to enroll you.

This process causes delays and you might miss a desired start date as a result. In complicated MRMIP enrollment situations, the PCIP, which is apparently not trained on how MRMIP actually works, may hold up application paperwork for several weeks requiring the applicant to provide certain additional documents. Even if you check MRMIP only on your application, PCIP still has to vet your application before forwarding to MRMIP.

Unfortunately, MRMIP only has liaison with PCIP and they sometimes have difficulty explaining to the PCIP the eligibility rules as they pertain specifically to MRMIP. Trust me, I have been on a phone call or two like that. It can get very frustrating especially when MRMIP is getting ready to close 1st of the month slots and your application is still sitting at PCIP.

I understand that the system is in place to ensure that no one accidentally enrolls in MRMIP if they are actually eligible for PCIP. However, the process slows down the rollover to the MRMIP and I personally feel that there should be at least one MRMIP specialist in Folsom assisting up front with the applications.

So, if you want MRMIP, submit your paperwork a couple of months prior to the desired effective month to give yourself enough time to clear the PCIP.

Information about MRMIP and PCIP, including brochure, rate guide and application forms can be found on my web site at MRMIP/PCIP.

Dave
www.an-insurance.com

PCIP To Agents: Thanks, now take a hike!

The federal PCIP (and those states who have the federal PCIP instead of a state run version) announced today that effective May 1, PCIP will discontinue the agent/broker referral fee. PCIP claims that the enrollment numbers in the PCIP have 'increased dramatically' in the last six months and they no longer need agents/brokers to assist individuals with the plan benefits and enrollment.

Coincidentally, the dramatic enrollment increase was experienced during the short cycle that federal PCIP actually paid the one-time referral fee to agents and brokers to assist with enrollment into the program.

In California, the PCIP is run by the state via MRMIB and initially paid a $50 one-time referral fee identical to MRMIP. When federal PCIP added agent compensation in October, 2011 to try and increase enrollments, they offered $100 per applicant and CA PCIP increased the fee to $100 one-time to match the federal PCIP. Six months later, federal PCIP is cancelling the referral fee altogether and I would expect CA PCIP to either reduce back to $50 or down to zero to match federal PCIP.

This is bad news for individuals seeking assistance with PCIP benefits, formularies, provider networks and enrollment in the PCIP. I have enrolled quite a few people in both MRMIP and PCIP in recent months and neither has been a particularly easy process. I continually get calls from people who already applied for PCIP and were never enrolled, PCIP never received their application paperwork, or they were denied enrollment for reasons that were at best 'unclear'.

Sadly, the end result of this action, in addition to other recent anti-agent actions, will be further attrition of experienced health insurance agents willing to work with people under 65.

Dave
www.an-insurance.com