This is a common phenomenon for those who stray outside the white-picket-fence world of employer-sponsored group coverage. Last weekend I came across another smart, savvy tech pro who got rejected for individual coverage and didn't immediately find info about this critical program. I'm not a big SEO guy, no doubt to the detriment of my traffic volume, but this information really needs to make its way up the Google rankings: for the heck of it I ran a number of searches myself, and info is just as obscure today as it was four years ago when I went looking for help on this issue.
So here's the executive summary:
- California's "Major Risk Medical Insurance Program" or MRMIP is a state-administered program that guarantees certain groups of individuals can buy a health insurance plan from a specific set of private-sector plans
- This program is mainly valuable to folks who need to obtain individual coverage (i.e. are not eligible for group coverage through an employer, union, etc.)
- You are eligible if you have been formally rejected for coverage in the last year or if you have been offered coverage at a more expensive rate than the current MRMIP program rates
- The program addresses accessibility of coverage, not affordability. I.e., it will help you get insured; it will not help you pay for it. Sadly, that means you more or less need some flavor of middle-class income to get your HMO on.
Considering this program lives at the unholy intersection of (a) government bureaucracy and (b) health insurance bureaucracy, it is well documented, easy to apply for, and easy to work with. YMMV, but I am speaking from personal experience, having struggled with the "I have no group coverage" problem and being happy with the solution MRMIP provided.
Ironically, once you know the magic keyword (MRMIP) it's easy to Google the rest of the data. But here are some direct links anyway:
2007 program brochure, which includes details on eligibility, carriers, coverage, prices, and the application form. The original is on the state's web site. Here's the program home page.
The program is administered under the auspices of the "Managed Risk Medical Insurance Board." If you're interested in the politics, policy, and future of this program, these notes are interesting.
Two last things worth noting:
First, there is an annual coverage cap of $75,000 on these plans. That seems like a lot of money, but in the US's insane healthcare economy it is very possible to run through that amount if something bad happens. For that reason it is still worth looking at which program offers the most potential care for $75k. I have a hunch that would be Kaiser, though I don't have all the data to back that claim up.
Second, although insurance companies seem to be getting more diligent about investigating your medical history, there may be the temptation to falsify or conceal various bits in order to get coverage, or to get a better rate. Doing so is hazardous.
If you get away with it in the short term, you may get some cheap doctor visits. But if you have a serious illness or injury, where the insurance company is looking at paying big bills, you can bet they'll put a fraud investigator on the case. If they can turn up evidence that you lied on your application, they'll deny your claims and probably try to terminate your coverage altogether. You could fight, but it would be a long uphill battle and not the kind you want to take on when you're already sick or hurt.
Bite the bullet, tell the truth, and if they tell you to get lost, programs like MRMIP can help.
5 comments:
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Some policies dictate that certain types of medical expenses are not subjected to the deductible while other types are. For example it is non uncommon for no deductible to apply to initial hospital and/or surgical expenses up to a specified amount. In a case like this, the insured would pay no deductible in expenses but would first pay the deductible before major medical covered any additional expenses. The insurer and insured would then share in the remaining expenses at 80% and 20% or whatever the percentage is in their applied policy.
Other medical expense benefits fall into a category in addition to the hospital, surgical and medical benefits previously discussed. These optional benefits vary from insurer to insurer and may or may not include as part of their standard policies. Separate policies can sometimes be written to include these benefits.
Regular medical expense benefit is another category that is sometimes known as physician’s non-surgical expense. This coverage is for non-surgical services a physician provides and can sometimes be narrowly applied to physician visits while the patient is in the hospital.
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