The Covered California CalHEERS online enrollment system continues to be upgraded to fix problems and accommodate household changes, but Certified Insurance Agents (CIA) are rarely notified of the updates. As CIAs helped enroll 40% of Covered California’s households and continue to update their clients changes through the system, agents deserve to be provided regular updates from Covered California on changes to CalHEERS.
Agents in the dark about Covered California changes
All too often agents are learning about the limitations of the Covered California system by trial and error when reporting changes to an existing clients enrollment. These “errors” would be mostly preventable if Covered California would just issue better guidelines on how to make certain household changes and update agents on system upgrades to address glitches in the software. The lack of communication has led to wasted hours and additional anxiety on the part of the agents and members.
Changes to reporting household income
The reporting of a change in a clients income has presented unexpected software issues. Initially, agents had to learn the hard way that you just dont increase or decrease wages, but you had to create a whole new income entry. If this wasnt done, the change would be retroactive to the beginning of the year artificially inflating or deflating the household income. One acquaintance detailed his frustrating interactions and how Covered California has updated their system.
June 20, 2014
Just tried to update my partners income on Covered CA for a reduction in self-employment income and increase in dividend income effective 6/1/14. Covered CA software totally screwed this up and added income rather than reducing it. Many, many months of software updates and I cant process a simple change? What is wrong with these people?
I did get a helpful person on the phone, but she was not able to correct the problem or cancel the incorrect updates. Right now I have a HELP ticket for someone higher up to correct the annual income summary and get my partner back to her original plan. I will never try an update again! Just deal with it at tax time I guess. Again, what is wrong just insane!
June 25, 2014
All of the income and deduction fields were zeroed out by CC IT support. When the CC Rep entered the new correct information the annual income summary was computed from 6-1-14 not 1-1-14, and again the Rep was not able to fix the problem. I was told something had changed in the last month and Reps no longer had access to correct effective dates on income. Short story – more screwed up than ever and a new HELP ticket starting today.
June 27, 2014
The second CC HELP ticket on this case was more effective than the firstand got most of the entries correct. The income is still entered as employment income rather than self-employment income, but the number is now correct. The effective date for the plan change is 5/1/14 rather than the original 4/1/14 or the next month 7/1/14, but I assume that will be resolved her 2014 tax return. Anyway, I guess that is good news that at least someone at Covered California, presumably an IT agent, can do updates and check most, but all, of their entries.
Agents maintain thousands of household enrollments
If neither the CC or IT staff can get a simple change of income correct, how do they expect agents, with no communication from Covered Californiaabout software changes, to serviceour 300,000 plus individual clients? If Covered Californiadidupdate how to report a change of income or how the CalHEERS program records it, CIAs should be notified of such changes.
Add a baby, lose a family
I encountered my own challenges just trying to simply add a newborn to a clients household. Because the CalHEERS program didnt seem to be recognizing the child properly, I called the CC staff for support. Long story short, the CC staff changes to the account has left everyone but the mother without health insurance. But I did receive this email from Covered California.
06/27/2014 08:46 AM
Summary: Covered California-Consumer Portal – Enrollment-AHBX
Your reported issue/request has been resolved with the following resolution:
A maintenance release has gone out this week where adding a newborn is supported.
An SCR will need to cancel the current plan, re-enroll with a back-dated application for 3/1/2014 WITHOUT the baby.
After selecting plan, the user can submit a change report to add the baby. An effective date will be sent out for the baby with a begin date of the baby’s birthdate.
Yet another maintenance release and no word from Covered California on how to use the new changes in the CalHEERS program. Of course, its probably a moot point since when I called the SCR the newborn was in the household. However, the carrier still hasnt included the newborn in the family plan.
System off-line for mysterious changes
Agents recently received the following email from Covered California.
The Covered California online application system will be down for maintenance from 8:00 PM on Saturday, June 28th to 6:00 AM on Monday June 30th. During the outage, the system will be unable to accept consumer applications.
Other than maintenance, there was no explanation as to why the system was going down or how it would be changed when it went back on-line.
New qualifying event drop down menu
From talking with a Covered California service center representative I learned the outage was to update the system to handle Special Enrollment Period qualifying events. I happen to be entering an application under the SEP rules and uponentering theinformation received the following pages.
Delayed eligibility determination
It would be great if Covered California could have updated the CIAs to expect this delay while they determine if the individuals life event qualifies for special enrollment. How long will the determination for eligibility take? Should the agent supply any documentation? Of course, no documentation is requested for eligibility determination.
No information leads to wasted time
If Covered California would just communicate with the agents we would be able to avoid lost hours trying to figure out how to navigate the enrollment system. We could also keep our clients in the loop about prospective delays and additional documentation. As it stands today, the only people who Covered California thinks are either enrolling new households or making changes to existing accounts are the service center representatives.
Agents want to be partners with Covered California
All the CIAs and CECs want is to be treated like equal partners when it comes to using the CalHEERS program. If the explanation of the maintenance releases and program changes are good enough for the service center staff, they are certainly appropriate for agents who also help Californians enroll and maintain their accounts.