The new California Franchise Tax Board (FTB) 3895 is a close mirror image of the federal 1095A. The FTB 3895 statement reports important data regarding your health insurance through Covered California such as the monthly premiums, Second Lowest Cost Silver Plan, and how much Covered California paid to your health insurance company to lower your premiums.
The Shop and Compare Tool calculated the subsidized rates for each Silver 70 health plan for 2021. When compared to 2020, the monthly health insurance premium for the 55-year-old individual increased between 25 and 160 percent. Kaiser, the least expensive Silver plan, had the largest dollar increase of $175 per month. Without the Oscar expansion, the Blue Shield HMO Silver 70 would have been the SLCSP, but the much less expensive Oscar Silver plan came in second, $139 lower after the subsidy.
The confusion lies in the statement that the consumer is not eligible for the California Premium Subsidy. The California Premium Subsidy program is completely separate from the federal Premium Tax Credit subsidy. You can be eligible for the federal subsidy but not the State subsidy. If your income is over 400 percent of the federal poverty level, you are not eligible for the federal Premium Tax Credit subsidy, but you may be eligible for the State subsidy.
The Department’s General Counsel Opinion Letter, issued pursuant to Insurance Code section 12921.9, was prepared in response to an inquiry from San Diego’s TransFamily Support Services regarding several denials of coverage for male chest surgery for patients under 18 years old who are transitioning from female to male. The Department determined that denying coverage for mastectomy and reconstruction of a male chest based solely on age is impermissible under state laws requiring coverage of reconstructive surgery. Health insurance companies must consider a patient’s specific clinical situation in determining medical necessity.
Health insurance is unique in that it not only protects you from catastrophic health insurance bills, it can also help reduce the costs of many routine health care services and prescription medications. It’s as if your car insurance gave you discounts on oil changes, tire rotations, or replacing your brakes. While some of us we need routine maintenance, most people don’t know when their transmission is going to die and it needs to be replaced.
Perhaps the oddest bit of information from J was that the son she gave birth to was also named Kevin. This gentleman was born in 1955. I was born in 1963 when my father was on his third(?) marriage. Was I named for the son my father had abandon in hopes of recreating some alternative reality with a happy ending? Again, this would not have been out of the realm of possibility for my magical thinking father.
Requiring health insurance policies to cover medically necessary prevention, diagnosis, and treatment of all mental health conditions, as well as substance use disorders, that are listed in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the mental and behavioral disorders chapter of the most recent edition of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10).
I will note that when selecting the UCLA Medical Group from the drop-down list on the L. A. Care website, it will specify that limited enrollment is available. I don’t know if that means only the participating primary care physicians will accept a limited number of L. A. Care members or if the entire UCLA Medical Group is limited.
Covered California does not pay agents to assist consumers with enrollments into individual and family plans. The insurance plan or carrier compensates the agent. Agents are not paid anything for answering questions about Covered California. They are only paid a commission if the person enrolls into a health plan the agent represents and is appointed with.
Now, it seems they have set up their communication structure in such a way as to thwart any meaningful discussion between them, agents or potential consumers. If I can’t access information for my clients, then I am not providing all the services my clients expect. If the health plan throws up barriers to my access, then it is not a functional health plan in my eyes.