In an effort to dull the impact of the bad news, Covered California released a statement late on a Friday afternoon detailing how many applications were effected by the previous week’s crash of their website. Covered California estimated that 14,500 applications that were started before the CalHEERS enrollment website went dead for five days may have to be resubmitted. Agents and consumers that started applications on February 17, 18, and 19, while the site was functioning but experiencing problems, before it completely crashed on the 20th may need to resubmit or start a whole new health plan application.
Corrupted applications equivalent to a small city
Covered California says that 6,500 consumers that selected a plan were impacted but no action is needed on their part. They are reassuring those agents and consumers that the health plan selections are being processed properly. Unfortunately, the track record of Covered California in regards to health plan enrollments is less than stellar. Anyone who applied for health insurance during this time frame, for an April 1st effective date, should be extra diligent in confirming their application is actually in the Covered California system and that the health insurance company also has their selection.
Covered California Certified Insurance Agent email announcement
IMPACT OF LAST WEEK’S SYSTEM OUTAGE
ATTENTION AGENTS: ACTION MAY BE NEEDED
Covered California is currently restoring data from applications completed during a software malfunction occurring Feb.17 through Feb. 19. Covered California is also calling on consumers and agents who started or updated incomplete applications during this period to re-submit their information.
The software error resulted in Covered California taking its online enrollment portal offline for several days. Online enrollment for the individual marketplace is now fully operational; however, some data submitted by agents and consumers during the affected time frame needs to be recovered and checked for accuracy.
Consumers and their certified insurance agents who submitted information between Feb. 17 and Feb. 19 have options available to them, depending on whether they completed the online enrollment process, started an application, or made updates to existing applications.
During the process of data recovery, information submitted between Feb. 17 and Feb. 19 may not be viewable, including completed applications, plan selection, partially completed applications, and updates to existing applications.
Who Are Impacted
About 6,500 consumers who completed their application and selected a plan are impacted but no action by the consumer is needed. These applications and plan selections are being processed by the health plan selected and the information will be fully restored by Covered California. These consumers must make their payment by the plan deadline for April 1 coverage.
Another 14,500 consumers who partially completed their applications or submitted updates to existing applications within the time frame are also affected. These consumers should either start a new application or resubmit any updates to an existing application. These consumers are urged to finalize their enrollment by March 15 for April 1 coverage.
An additional 16,000 consumers completed their applications and were determined likely eligible for Medi-Cal. Their applications are being processed by the county in which they are eligible, and that information has been fully restored by Covered California. Consumers’ applications may not be visible on CoveredCA.com until the restoration is complete. There is no action needed by these consumers, but if they have questions they should call their county human services agency.
The affected consumers visited Covered California’s online enrollment website between 1 a.m. Monday, Feb. 17 and 1:30 p.m. Wednesday, Feb. 19. Consumers, including those qualifying for Medi-Cal coverage, who completed applications or updated information prior or after that isolated time frame are not impacted. Paper applications were not affected by the online enrollment malfunctions.
Covered California will reach out to consumers as needed if they enrolled in a Covered California health insurance plan, partially completed an application, or submitted updates during this time frame to advise them of the status of their application and offer them assistance. No personal data were compromised during the software problem or the outage.
System outage clogs phone lines again
This massive failure of the Covered California enrollment website will further exacerbate the already clogged telephone lines greeting consumers looking for information and help. On Friday February 28th Covered California had a recorded message on their help line that the enrollment website was once again down for maintenance leaving agents in the dark about how to help clients.
Feds realize California is foundering
Prior to Covered California’s sheepish press release of how they continue to torture consumers with an enrollment website that has more problems than they will acknowledge, the Center for Medicare and Medicaid Services (CMS) announced a reprieve for individuals and families shut out of purchasing a health plan through either the federal or a state exchange. CMS will alter the rules and allow the Advanced Premium Tax Credits (APTC) and any Cost Sharing Reduction (CSR) of copayments to be extended to households that had to purchase a qualified health plan outside of the exchange if the exchange website couldn’t process their application.
Retroactive tax credits for households shut out of ACA health plans
To be eligible for the the federal tax credit a household must purchase a health plan through the exchange that verifies the income, residency and immigration status. The prospective tax credit does not have to be applied to the monthly premium but can be taken at the time of filing the federal taxes in the following year. The new rules were specifically drafted because enrollment websites like Covered California have failed on numerous occasions to deliver on the promise of getting health insurance to families that properly applied.
CMS announcement exceptional circumstances
This guidance is being provided to Marketplaces that, due to technical issues in establishing automated eligibility and enrollment functionality, have had difficulty in providing timely eligibility determinations to applicants and enrolling qualified individuals in Qualified Health Plans (QHPs) through the Marketplace during the initial open enrollment period for the 2014 coverage year. Such a circumstance may be considered an exceptional circumstance for individuals who were unable to enroll in a QHP through the Marketplace due to these issues. – CMS Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances, February 27th, 2014
Exchange and health plans must credit or refund payments
Further, if the household was eligible not only for the APTC, but also CSRs, the exchange and the health plan must work together to refund any excess copayments or coinsurance the family incurred as a result of not be properly enrolled in health plan through the exchange. Download the full CMS Bulletin at the end of the post.
In both of the situations described above, if an individual is determined eligible for retroactive CSRs or advance payments of the PTC, the issuer of the QHP will be required to adjudicate or re-adjudicate, as applicable, the enrollee’s claims incurred during the retroactive period, and refund or credit to the enrollee any excess cost sharing or premiums paid if applicable, and ensure the provision of refunds or credits of any excess payments made by or for the enrollee for covered benefits and services incurred during the retroactive coverage period. – CMS Bulletin
How do you corrupt a whole city of applications?
To a certain extent, this ruling by CMS is saving the back side of Covered California and other state exchanges that can’t get their online enrollment systems to work. Aside from a little press release, it is doubtful that any marketing effort will be exerted to notify individuals or families that had their applications compromised by the Covered California system. The management at Covered California, as usual, will continue to act like nothing has ever happened but some of the 14,500 applicants will know better when they realize their applications are permanently corrupted by a failed online exchange system.
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