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Results from search: http://www.miec.com/
Medical Insurance Exchange of California - Professional Liability Insurance
Serving Alaska, California,
Hawaii, Idaho and Nevada
Welcome to
MIEC, the West's first physician-owned professional liability
company. Together with our subsidiary, Claremont Liability
Insurance Company, we cover more than 6,000 physicians and other
health care professionals.
Medical Insurance Exchange of California
Claremont Liability Insurance Company
Medical Underwriters of California
Management Company
6250 Claremont
Avenue Oakland, CA
94618
800.227.4527 Fax
510.654.4634
Medical Insurance Exchange of California
(License #R260)
Claremont Liability Insurance
Company (License #6379)
Copyright © 2000
Medical Insurance Exchange of CA
Results from search: http://www.healthyfamilies.ca.gov/
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The
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Results from search: http://www.mrmib.ca.gov/MRMIB/MRMIP.html
MRMIP - TOC and Introduction
Introduction
Eligibility
Applicants Who Know They Are Currently Not Eligible
But
Expect To Be in the Future
Agents/Brokers, Employers and Applicants
Medi-Cal Beneficiaries
How the Program Works
Choosing a Health Plan
Benefits and Copayments
Pre-Existing Condition Exclusion Period for Blue
Cross
and Blue Shield PPO Subscribers
Post-Enrollment Waiting Period for Blue Shield
HMO,
Contra Costa Health Plan, Kaiser Permanente and Maxicare
How You May Waive All or Part of the
Exclusion/Waiting
Period
Dependent Coverage Information
Waiting List
Transfer of Enrollment
Disenrollment
Dispute Resolution/Appeals
Binding Arbitration
Coverage Brochures
Coordination of Benefits
Description of Plans and Benefit Highlights
Blue Cross of California
Blue Shield of California-
Access + HMO
Blue Shield of California-
Preferred Plan
Contra Costa Health
Plan
Kaiser Permanente Northern
California
Kaiser Permanente
Southern California
Subscriber Contribution by County Charts
Area 1 Rates
Area 2 Rates
Area 3 Rates
Area 4 Rates
Area 5 Rates
Area 6 Rates
Application
For more information call 1-800-289-6574
Introduction
The California Major Risk Medical Insurance Program (MRMIP) is an
innovative
MRMIP developed to provide health insurance for Californians who are
unable
to obtain coverage on the open market. The MRMIP is administered by a
five-member
Board who has established a comprehensive benefit package. Services in
the
MRMIP will be delivered through contracts with health insurance
providers.
Californians qualifying for the MRMIP will participate in the payment for
the cost of their coverage by paying premiums on their own behalf. The
MRMIP
will supplement those premiums to cover the cost of care. The MRMIP is
funded
by $40 million from tobacco tax funds.
Eligibility
Requirements
In order to be eligible for the Major Risk Medical Insurance Program:
You must be a resident of the state of California. A resident is a
person
who is present in California with intent to remain in California except
when absent for transitory or temporary purposes. However, a person
who
is absent from the state for a period greater than 180 consecutive
days
shall not be considered a resident.
You cannot be eligible for both Part A and Part B of Medicare, unless
eligible solely because of end-stage renal disease. (Being eligible for
one part or the other is acceptable.)
You cannot be eligible to purchase any health insurance for
continuation
of benefits under COBRA or CalCOBRA. (COBRA and CalCOBRA refers to
the federal law giving
people
under certain circumstances the right to continue coverage in an
employee
health plan for a limited time.) If you have COBRA or CalCOBRA you may
apply for
deferred
enrollment.
You must be unable to secure adequate coverage. This can be
demonstrated
in any of four ways:
If you have been denied individual coverage within the previous
12 months. A letter/copy of letter from a health insurance carrier
or health plan or health maintenance organization denying individual
coverage within the last 12 months must be submitted with your
completed
application.
If you have been involuntarily terminated for health insurance
coverage
within the previous 12 months for reasons other than nonpayment of
premium or fraud. A letter/copy of letter indicating involuntary
termination
from a health insurance carrier or health plan or health maintenance
organization or employer for reasons other than nonpayment of
premium
or fraud must be submitted with your completed application.
If you have been offered, in the previous 12 months, an individual,
not a group, health insurance premium in excess of the Major Risk
Medical Insurance Program subscriber rate for your first-choice
participating
health plan. A letter/copy of letter must be submitted with the
completed
application indicating that, within the last 12 months, you have been
offered by a health insurance carrier or health plan or health
maintenance
organization, a premium for the subscriber and/or their dependents
(when applicable) in excess of the MRMIP rate for the subscriber
and/or
their dependents.
If you are a member of a group of two or fewer (not including
dependents)
who has been denied health insurance coverage in the previous 12
months.
A letter/copy of letter indicating that a member of a group of two
or less has been denied by a health insurance carrier or health plan
or health maintenance organization for health insurance coverage
within
the last 12 months must be submitted with your completed
application.
Note: Letters from agents/brokers indicating that an individual is unable
to secure adequate private coverage will not be accepted as
documentation
for eligibility.
Applicants
Who Know
They Are Currently Not Eligible But Expect To Be in the
Future
If you are not currently eligible for the MRMIP, but anticipate becoming
eligible, you may also apply for this MRMIP. Examples of this are: if you
are currently enrolled in COBRA or CalCOBRA coverage or if your employer
has informed
you that you will be involuntarily terminated from insurance coverage
sometime
in the future.
To apply for a deferred enrollment, indicate when you will become
eligible
and include acceptable documentation. Acceptable documentation is a
letter
from a health insurance carrier or employer indicating when your
coverage
will end. The documentation must specify the exact date of termination
of
current coverage. Enrollment in temporary policies does not qualify for
deferred status.
If the MRMIP is not at maximum enrollment and all other eligibility
criteria are met, you will be enrolled in the MRMIP on the date that
eligibility
will occur. If the MRMIP is at maximum enrollment at the time you
become
eligible, your place on any waiting list is determined by the date on which
you originally applied, not the date that you became eligible for the
MRMIP.
Applicants for deferred enrollment must submit their initial
subscription
contribution with their application.
Payment will be refunded to you immediately if your deferred
effective
date is more than sixty (60) days from the date we receive your
application.
Agents/Brokers, Employers
and Applicants
Insurance Code Section 12725.5 states that it shall constitute unfair
competition
for an insurer, an insurance agent or broker, or administrator to refer an
individual employee, or their dependent(s) to apply to this MRMIP, for
the
purpose of separating that employee, or their dependent(s) from group
health
coverage provided in connection with the employee's employment.
Insurance Code Section 12725.5 further states that it shall
constitute
an unfair labor practice contrary to public policy for any employer to
refer
an individual employee, or their dependent(s) to this MRMIP, or to
arrange
for an individual employee, or their dependent(s) to apply to the
MRMIP,
for the purpose of separating that employee, or their dependent(s) from
group health coverage provided in connection with the employee's
employment.
Medi-Cal
Beneficiaries
While Medi-Cal beneficiaries are not prohibited from enrolling in the Major
Risk Medical Insurance Program, a Medi-Cal beneficiary should carefully
consider
the cost before signing up for our additional coverage. MRMIP subscribers
are responsible for their monthly subscriber contributions, a deductible
and/or
a copayment for services which could be up to $4,000 per year. Medi-
labels
cannot be used for MRMIP copayments.
How
the Program Works
Benefits
and Copayments
Subscriber may choose from any plan available to them as listed in the
enclosed
subscriber contribution by county charts. Description of
Plans
and Benefit Highlights and are also available by calling any MRMIP
health
plan at their toll-free number and asking for an Evidence of Coverage or
Certificate
of Insurance.
Subscribers will be responsible for their monthly subscriber
contribution
whether or not they receive a bill in that month. Subscribers may choose
from any plan available to them as listed in the Subscriber
Contribution by County Charts .
Health Maintenance Organizations (HMOs) in the MRMIP require a fixed
dollar
co-payment for some services and up to a 20% co-payment for other
services.
The Preferred Provider Organizations (PPOs) in the MRMIP may also
require
a fixed dollar co-payment for certain services and up to a 25% co-
payment
for other services. The out-of-pocket maximum per
calendar
year for all MRMIP plans is $2,500 for individuals and $4,000 for an
entire
household covered by the MRMIP. This maximum does not apply to
services
recieved by providers that do not participate in the subscriber's chosen
health plan's provider network, or to services not covered by MRMIP.
There
are MRMIP benefit limits of $75,000 per calendar year and $750,000 in a
lifetime.
Subscriber contribution amounts are updated on January first of each
year.
In addition, your subscriber contribution may change during the year if
your birthday moves you into a new age category. For married
subscribers
enrolled under two-party or family coverage, the age rating category will
be based on the age of the subscriber. Adjustments to subscriber
contributions
due to age changes will occur on the first of the month following the
birthdate.
Subscriber contributions may also change when
a member
moves from one area of the state to another. Adjustments to
subscriber contributions
will occur on the first of the month following notification of the move.
Each month you will receive a subscriber contribution notice from MRMIP.
Subscriber contributions are payable in advance and are due the first day
of every month. A subscriber contribution notice will be generated
monthly,
and will be sent out 30 days prior to the due date.
A delinquency billing or final notice will be sent out on the 15th day
following the paid to date.
There is a grace period of 31 days from the paid to date, and the
member's
coverage will remain in effect during this time.
Cancellation for nonpayment of subscriber contribution will take place
on the 32nd day following the paid to date. The cancellation will be
retroactive
to the paid to date, and a cancellation letter will be generated to the
subscriber.
A subscriber may pay either by check or money order. In addition, a
subscriber
may elect to have their monthly subscriber contribution automatically
deducted
from their checking account when accepted into the MRMIP.
Subscriber contribution checks that are returned to the subscriber's
bank
will result in disenrollment back to the last month(s) paid. The subscriber
may be reinstated upon request only if membership history indicates
that
cancellations of the same subscriber have not exceeded two instances in
a rolling 12 month period. The replacement check must include
subscriber
contributions to bring the account to current status with an additional
$25.00 NSF processing fee and must be received within the 31 day grace
period.
There is no application fee for applying to this MRMIP.
You
are required to submit your first month's subscriber contribution for
MRMIP
health care coverage, which is completely applied toward your first
month
of coverage if you are enrolled. Qualified insurance agents and brokers
may be paid a $50 fee by the state for explaining the MRMIP and
assisting
you in completing the application. The state does not require an individual
applying to this MRMIP to pay any fee, charge or commission to a
broker
or agent.
Pre-
Existing Condition
Exclusion Period for Blue Cross and Blue Shield PPO
Subscribers
For individuals who are enrolled in a participating health plan offering a
Preferred Provider Organization (PPO), there is a pre-existing condition
exclusion
period of 90 days. During this period, no benefits or services related to
a pre-existing condition shall be covered. Subscribers shall be required to
pay subscriber contributions during this period.
Results from search: http://www.bluecrossca.com/
BlueCross CA
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Results from search: http://www.healthinsur.com/
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