Notice to Enrollees Regarding Coverage
Effective January 1, 2003, in order to make health benefit coverage available to more Californians who cannot obtain health benefits because of medical conditions, Assembly Bill 1401(Thomson) was enacted to limit the length of participation in the Major Risk Medical Insurance Program (MRMIP) to 36 months. At the end of this period, MRMIP enrollees are given a one-time opportunity to purchase guaranteed health coverage through any health insurance company or health care service plan (HMO) currently marketing coverage to individuals in California.

Post-MRMIP Graduate Plan -- Guaranteed Coverage
Under a new pilot program, which began September 1, 2003 and which will be in effect at least through September 1, 2007, individuals who will leave the Major Risk Medical Insurance Program ("MRMIP") following 36 months of coverage under the Program are eligible to purchase individual coverage on a guaranteed basis. If you have been notified by the MRMIB that your coverage under the MRMIP Program will terminate due to the new 36 month time limit for coverage, you may continue to receive coverage on a guaranteed basis with one of the Post-MRMIP Graduate Plans of your choice, regardless of which MRMIP plan provided your health care coverage under the MRMIP Program. Here are some facts:

• Affected enrollees are mailed a Notice 90 days prior to the disenrollment effective date. Forty-five days prior to the disenrollment date, they are mailed a Certificate of Program Completion that will enable them to obtain similar coverage in the individual market. This Certificate must be provided to the plan of your choice on application in order to obtain the guaranteed Standard Benefit Plan.

• Each health care service plan and insurance carrier currently marketing comprehensive individual medical coverage in California are required to offer a Standard Benefit Plan that is substantially the same as coverage available through MRMIP.

• MRMIP participants who receive disenrollment notices from MRMIP have 63 days from the termination effective date to enroll or submit an application for benefits under an individual health care service plan (HMO) or insurance policy from any managed care company or insurance carrier currently marketing individual coverage. The covered person cannot be eligible for Medicare Part A and Part B (unless it is due to end-stage renal disease).

• Health plan companies that participate in the individual health care market in California must offer a guaranteed issue product for MRMIP "graduates" at the indexed rate of 110% of the rate for MRMIP coverage.

• The plans currently in MRMIP are Blue Cross of California, Blue Shield of California (HMO) (As of 1/1/04, Blue Shield of California PPO Product is no longer offered), Contra Costa Health Plan and Kaiser Foundation Health Plan.

• Insurance companies offering individual health insurance policies are regulated by the California Department of Insurance and not the Department of Managed Health Care. These companies must also comply and are included in the Composite Comparative Benefit Matrix for all individual carriers offering Post-MRMIP Graduate Plans.

• If you need further assistance, please contact the individual health care service plan (HMO) or insurance company at the number listed in the Matrix.

• Contact the Department of Managed Health Care for further information.

• MRMIP is administered by the Managed Risk Medical Insurance Board. For questions regarding this program, please contact the MRMIB at:

  Mailing Address:	MRMIP
  	Post Office Box 2769
  	Sacramento, CA 95812-2769
  Phone Number:	(800) 289-6574
  Website:	http://www.mrmib.ca.gov/

The Composite Comparative Benefit Matrix (pdf, 71 kb) is designed to aid in plan selection by identifying the Post-MRMIP Graduate Plans and enabling a comparison of benefits, co-payments and limitations available through each plan. The matrix also contains information on eligibility for coverage, selection of providers, renewal of coverage, termination of coverage and annual and lifetime benefit maximums required by the new law.

Adjustments to the Monthly Subscriber Contribution Rates
AB 1401 requires that Californians eligible for enrollment in the Post-MRMIP Graduate Program must participate in the payment of the cost of their coverage by paying a monthly subscriber contribution or premium. Monthly contribution or premium rates for the Post-MRMIP Graduate plans are set by AB 1401 at 110% of the rates that an individual would pay under the MRMIP for the same standard benefit design.

Please refer to the 2004 Rate Chart (pdf, 87 kb) on this web site to compare rates that would apply to you. The Chart sets forth the monthly subscriber contribution rates by rating group [e.g., subscriber only, subscriber and number of dependents], subscriber age and geographic area in which coverage is available from a participating Health Plan. As noted in the Chart, not all plans offer the Post-MRMIP Graduate Plan coverage in all areas or in every zip code within a County.

Further information regarding terms of coverage, eligibility (including eligibility for dependents), benefits, rates, and areas in which coverage is available from a particular plan may be obtained by contacting the health plan at the telephone number or web site, if available, listed on the comparative benefits matrix.

The participating Post-MRMIP Graduate plans have elected to offer the MRMIP standard benefit designs as noted:

• Blue Cross of California, MEGA Life and Health Insurance Company, Mid-West National Insurance Company, PacifiCare Life and Health Insurance Company and Fortis Insurance Company will offer its Blue Cross PPO standard benefits design.

• Blue Shield of California, will offer its HMO standard benefit design,

• Health Net of California will offer the Blue Shield of California Elect Open Access HMO standard benefit design,

• Kaiser Foundation Health Plan, Watts Health Plan and Chinese Community Health Plan will offer the Kaiser Foundation Health Plan standard benefit design.

Composite Comparative Benefit Matrix – All Plans
Composite Rates for All Plans All Areas (pdf, 87kb)

Expanded Comparative Benefit Matrix for Each Plan

• Blue Cross of California PPO (pdf, 23 kb)

• Blue Shield of California HMO (pdf, 15 kb) [Note, as of 1/1/04 Blue Shield's PPO product is no longer available. As of 1/1/04, Blue Shield will offer its HMO product in the Post MRMIP Graduate Program]

• Chinese Community Health Plan (pdf, 16 kb)

• Health Net of California, Inc. (pdf, 17 kb)

• Kaiser Foundation Health Plan (pdf, 19 kb)

• Universal Care (pdf, 15 kb)

• Watts Health Foundation, Inc. (pdf, 15 kb)

• MEGA Life Insurance Company (pdf, 71 kb)

• Mid-West National Life Insurance Company (pdf, 71 kb) 

• PacifiCare Health and Life Insurance Company (pdf, 71 kb)

• Fortis Insurance Company (pdf, 71 kb)

The California Department of Managed Health Care and the California Department of Insurance will both be posting on their respective websites combined benefit comparison matrices for all plans.

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