Questions About PCIP Benefits

• Do I have to choose a primary care provider?
• What do I have to do to receive the $50 Comprehensive Wellness Examination credit?
• What is a deductible?
• What is coinsurance?
• What is the difference between a copayment and coinsurance?
• What is the Plan Allowance?
• How do I find a provider that is participating in the PCIP PPO Network?
• How do I find out if my current provider is participating in the PCIP PPO Network?
• What if my provider is not participating in the PCIP PPO Network?
• Are emergency services covered if the provider is out-of-network?
• What is considered an emergency?
• What happens if I am injured or become ill while I am outside of California?
• How are Out-of-State Claims paid?
• What is the Maximum Out-of-Pocket Amount?
• What expenses count towards the Annual Out-of-Pocket Maximum?
• How can I track my claims and Out-of-Pocket Expenses?
• Which services require prior authorization?
• Who do I call for prior authorization?
• What can I do if PCIP doesn't authorize health care services I need?
• What can I do if my claim is denied or only partially paid?
• What can I do if I do not agree with a PCIP Benefits determination?
• How long does it take to resolve an appeal?
• What is an expedited appeal?
• How do I get my prescriptions filled?
• What if I get a prescripton filled at an out-of-network pharmacy?
• What is the difference in cost between an in-network and out-of-network pharmacy?
• Do I have to use a generic drug?
• What if I need a brand name drug?
• What if I need a specialty drug?
• How does the mail service prescription drug benefit work?
• What is Care Management?
• What is Disease Management?
• Who can I contact with questions about my PCIP enrollment, premium billing and statement?
• Who can I contact with questions about my PCIP claims?
• Is there anyone that can help me if I prefer to speak a language other than English?
• Can I speak to a nurse over the phone?
• What Health Education Resources are available to me as a subscriber?

Questions About PCIP Program

• What is a Pre-Existing Condition Insurance Plan (PCIP)?
• How Can I Apply for PCIP?
• Who Can Apply for PCIP?
• Does PCIP offer dependent coverage?
• How much will the monthly premium cost for PCIP?
• How do I know if I am eligible for PCIP?
• Will I qualify for the PCIP if I currently have Share of Cost (SOC) Medi-Cal?
• What are acceptable U.S. Citizenship and U.S. National documents for PCIP?
• What are acceptable immigration documents for PCIP?
• How do I pay my PCIP monthly premiums, once I am enrolled?
• Which plans will be available for PCIP?
• How can I find a PCIP PPO Network Provider?
• Does PCIP cover dental and vision care?
• What are the health benefits offered in PCIP?
• What is the co-payment for PCIP services?
• Is there an annual deductible for PCIP?
• Does PCIP have a cap on how much I have to pay out of pocket each year?
• How long does it take to process my PCIP Application?
• What is the difference between my PCIP Member Number and Subscriber ID Number?
• How can I appeal a PCIP eligibility decision?
• Can insurance brokers/agents assist people in applying for PCIP?
• How much will insurance brokers/agents receive for assisting people to enroll into PCIP?
• When will payments begin for insurance brokers/agents?
• Will PCIP cover any medical expenseses that I received before my coverage begins?
  
• I am currently interested in enrolling in MRMIP only? Is it possible for me to enroll in MRMIP without being considered for PCIP?
• What does it mean that I cannot have health coverage for the last 6 months, in order to qualify for PCIP?
• If I had health coverage in the last 6 months, why don’t I qualify for PCIP? I have a pre-existing condition and I cannot be without health coverage for 6 months.
• Why do I have to fill out a MRMIP Application if I want to apply for PCIP?
• What are the different eligibility rules for the PCIP and MRMIP programs?
• How do I show that I am medically-uninsurable for the PCIP program?
• I am currently enrolled in MRMIP program, may I apply for PCIP?
• I am currently enrolled in MRMIP. MRMIP has an annual benefit cap of $75,000 per calendar year and a $750,000 lifetime cap. Can I apply for PCIP, when I reach the MRMIP benefit or lifetime cap limit?
• If I qualify for both programs, which program will I be enrolled?
• I want to know if there is a waiting list for the Major Risk Medical Insurance Program (MRMIP)?
• If I am disenrolled from PCIP, when am I eligible to re-enroll?