Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Covered California has awarded quality star ratings to health plans based on just two questions from a questionnaire surveying consumer’s experience in 2014. In addition, the quality ratings were based on a completed sample size of approximately 100 respondents out of 1,000 surveys sent out.
Covered California has released new Job Aids that review and describe some of the changes they have made to their online enrollment application. Many of the new functions address deficiencies in the original software, other features to help consumers more easily report changes, and the new addition of enrolling in a family dental plan.
Covered California Certified Insurance Agents assisted 429,365 individuals for possible enrollment into the expanded ACA Medi-Cal health insurance from January 1, 2014 through July 31st, 2015. The Medi-Cal assistance enrollment figure comes from a Public Records Act Request that I submitted in early October of 2015 to Covered California. As the $58 compensation to agents for Medi-Cal enrollments ceased over the summer I felt it was important to learn the level of agent involvement with funneling Californians in Medi-Cal health plans.
I wouldn’t have believed if I had not seen with my own eyes. For months the Covered California account of a client showed one of the household members enrolled in an Anthem Blue Cross plan. Then one day it disappeared. All Covered California can say is that they don’t see the member ever being enrolled. The client continues to pay for the phantom Anthem Blue Cross that Covered California says never existed. How was this enrollment information erased?
One of the most frustrating aspects of the Affordable Care Act is that it excludes family members from receiving the premium tax credits to reduce their health insurance if one of the parents is offered affordable employer group health insurance. One way around this problem is for the employer to offer employee only coverage. Covered California for Small Business health insurance exchange offers the employee only option for employers when they set up their group health plans.
Individual and family plans offered through Covered California in 2016 will include new pharmacy prescription drug benefits. The benefit, also mirrored in many off-exchange health plans, caps the amount a consumer must pay every month for a particular prescription. While that sounds straight forward, the rules surrounding any pharmacy deductible and tiered drug formulary can be complicated and confusing.
Covered California has locked Certified Insurance Agents into representing all exchange plans to consumers and forbids agents from steering consumers to health plans with the best commission structures. Unfortunately, Covered California has no regulations that address any minimum compensation levels that the health plans or health insurance companies must pay agents for their efforts. Covered California announced over the summer that compensation for Medi-Cal enrollments would end for agents. Most recently Western Health Advantage (WHA) announced a split commission structure where Certified Agent enrolments would receive less compensation for Covered California plans than WHA’s off-exchange plans.
Many Californians have realized that when they report a change to their Covered California accounts during the year they are hit with higher health insurance premiums. This occurs when the change reported is after a consumer’s birthday. Any change within the Covered California CalHEERS online enrollment program automatically triggers the application for health insurance to be resubmitted for an eligibility determination. The new eligibility is calculated as of the individual’s age at the time of the reported change.
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.
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, […]
