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Major Risk Medical Insurance Program (MRMIP)

The California Major Risk Medical Insurance Program (MRMIP) is an innovative program developed to provide health insurance for Californians who are unable to obtain coverage on the open market. The Program is funded by $40 million from the state’s tobacco tax fund, and it’s administered by a five-member board. It provides a comprehensive benefit package. Services in the program are delivered through contracts with health insurance providers. Californians qualifying for the program share the cost of their coverage by paying premiums on their own behalf. The program supplements those premiums to cover the cost of care.

In order to be eligible for the program:

  1. You must be a resident of the state of California.
  2. You cannot be eligible for Medicare.
  3. You cannot be eligible to purchase any health insurance for continuation of benefits under COBRA (COBRA 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, you may apply for deferred enrollment.
  4. You must be unable to secure adequate coverage (see MRMIP application for specific requirements).

How the program works
You can choose from any plan available through MRMIP. The options for health plans that are available depend on the county you live in. The rates are based on where you live and your age.

Health maintenance organizations (HMOs) in the MRMIP require a fixed dollar co-payment for some services and up to a 20 percent 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 percent 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.

The premium amounts are updated on January 1 of each year. In addition, your contribution may change during the year if your birthday moves you into a new age category. The premium may also change if you move from one area of the state to another.

For more information on the MRMIP, you can call (800) 289-6574 (Blue Cross).