Covered California considers advertising vision insurance plans

Covered California ponders offering vision insurance on their website in 2016.

At the August 2015 Covered California Board meeting James DeBeneditti, Deputy Director of Plan Management, reviewed the options and challenges for offering vision insurance on the Covered California online enrollment website. The only viable option reported was to put a simple link on the Covered California website to vision insurance providers. For the inclusion of the hyperlink Covered California would charge $10,000 and take a 10% commission. The $10,000 implementation fee is essentially an advertising cost for the vision plan while Covered California acts like an unlicensed insurance agent collecting a 10% commission for selling vision insurance.


Covered California launches new small group marketing

Covered California launches new video marketing to drive business to their small employer group health plans.

Covered California has released a series of marketing videos to develop interest and drive sales to their small employer group plans. Formerly known as SHOP (Small business Health insurance Options Program), the small employer group offerings, authorized as part of the Affordable Care Act, has been re-branded as Covered California for Small Business. The small employer group marketplace exchange initially flopped as it was beset with an online application process that failed and subsequent management problems that resulted in billing nightmares for many clients. Fortunately, they seem to have righted the foundering small group boat at Covered California.


California family health insurance 2016 rate filings

The formal rate notifications to the state of California for the various individual and family health insurance plans.

Whenever a health insurance company or health plan wants to change their health insurance rates in California they must submit a justification for the rate change in the monthly premium amounts to the Department of Managed Health Care or Department of Insurance. Regardless of which agency they must submit their rates to, the agencies just […]


Parents giddy over Williams College freshman send-off party

Proud parents were anxious and excited about their child attending Williams College in the fall, so far away from California.

On the third floor of the University Club of San Francisco was a gathering of complete strangers. The common element among the participants was that many of young adults would soon be leaving to begin their freshmen year at Williams College. The remaining guests in the collegiate wood paneled room on top of Nob Hill […]


Accessing benefits under dual eligible special needs plans

Woman Using an Inhaler

Anthem Blue Cross of California Medicare Advantage dual eligibility with Medi-Cal Special Needs Plans May 30, 2015 This guidance is generally applicable for all health insurance companies that offer Medicare Advantage Special Needs Plans for dual eligible beneficiaries. Dual Eligibles (Duals) are individuals who are entitled to benefits from both the federal Medicare and state-run […]


Medicare Coordination of benefits, payments, and denials

Under coordination of benefits, Medicare may not pay for health care from a traffic accident if liability rests with the other driver and their insurance.

There are certain situations where Medicare will pay for your health care services after another insurance plan pays first. There are also situations where Medicare will pay for your health care services, but you will have to pay them back after an insurance settlement reach after an accident you are involved with that is not […]


Making sense of Medicare’s Prescription Drug Plan with training

Center for Medicare and Medicaid Services training module for Prescription Drug Plans, 2015.

2015 CMS PDP Training Prescription drug coverage for Medicare beneficiaries can be confusing. Under different health care scenarios some drugs may be covered by Part A, Part B or Part D of Medicare. In addition, many Medicare beneficiaries may be unaware that they might qualify for extra help to pay for their medications. The Centers […]


Covered California verification letters absent from member’s accounts

Verification notices are not being posted to Covered California consumer accounts.

Covered California has been sending out a variety of letters notifying consumers that they must send in verification for such items as proof of income, citizenship and Social Security numbers. Unfortunately, these letters are not being reflected in the consumer’s Covered California Documents & Correspondence Summary section. Letters are missing from Summary section To date, […]


Most California Navigators failed to meet 2015 enrollment goals

Most Covered California 2015 Navigators failed to meet enrollment goals, but still collected 50% of their grant award.

A review of Covered California Navigator enrollment and payment data for 2015 reveals that a majority of organizations awarded grant money to enroll individuals and families in qualified health plans failed to meet their enrollment goals stipulated in the grant award agreements. Fifty-five of the Sixty-five organizations listed that received Navigator grants failed to meet […]