Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
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, […]
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 […]
A group of Covered California Certified Insurance Agents have begun organizing the early stages of a class action lawsuit against Covered California for unpaid compensation. Led by John Dickey who earlier took Covered California to small claims court, the goal is to enlist enough health insurance agents with verifiable losses to establish a base for […]
Covered California announced in mid-July they were awarding $10 million in grants to a Navigator program that performed poorly in 2015. Two weeks later Covered California sent out a letter to agents that they would no longer be compensated for assisting individuals and families who are determined eligible for Medi-Cal. For the 2015 open enrollment […]
Covered California has released the preliminary health insurance rates for 2016 conveniently avoiding telling some consumers that they will see a 30% to 44% increase in their monthly rates. While Covered California was massaging the statistics to promote a statewide weighted average increase of only 4%, consumers enrolled in some Blue Shield plans in Northern […]
Covered California has released a list of new and updated documents to help Certified Insurance Agents and Certified Enrollment Counselors assist existing Marketplace exchange members renew their health insurance for 2016. The focus of the renewal tool kit is on consent for verification, immigration and lawful presence, consumers who haven’t filed a 2014 tax return, and […]
