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Covered California Application

Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.

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Covered California to verify Qualifying Events for Special Enrollment Periods

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Covered California has come under pointed criticism from the health insurance companies for their lack of verification of a consumer’s Qualifying Life Event (QLE) for a Special Enrollment Period (SEP). That will change as of August 1, 2016, when Covered California will start a program to randomly sample consumers who have enrolled in health plan outside of Open Enrollment under a QLE. Selected consumers will have to provide verification that they actually do have a QLE that makes them eligible to enroll outside of Open Enrollment such moving into California or the loss of minimum essential coverage like Medi-Cal or employer group coverage.

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Covered California’s new Ombudsman and PPO PCP for 2017

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Covered California will be adding two elements to the health plans sold through their marketplace exchange in 2017. The first is a new ombudsman program to help consumers fight with their private health insurance companies. The second is requiring that all PPO and EPO health plans assign a Primary Care Physician like HMO plans have. Any initiative to help consumers navigate health insurance and the health care system are admirable. But both initiatives lack details that would help determine if the changes are lip-stick-on-a-pig or consequential improvements.

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Blue Shield, Covered California ignores lost SEP enrollment

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As is typically the case with enrollment disputes, Covered California says it is a Blue Shield problem and Blue Shield points the finger at Covered California. Blue Shield further states that they must wait 30 days before they request another transfer of the enrollment data from Covered California. So where does this leave the family? They have paid for health insurance in July for which they have no enrollment.

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Orange County Medi-Cal corrupts Covered California consumer account

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One Orange County Medi-Cal eligibility worker not only made his necessary changes to the consumer’s account, he also corrupted some information within the Covered California enrollment system. Because Medi-Cal puts a soft pause on the consumer’s account when one of the household members is eligible for Medi-Cal, only the county Medi-Cal worker can correct the wrong mailing address they created and reverse the Covered California consumer’s negative declaration of interest in subsidized health insurance.

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Blue Shield member premium rate scare letters

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Blue Shield has been sending confusing letters to their members that seem to indicate that the individual or family has lost their Covered California subsidy and they will now have to pay the full premium amount. These premium rate scare letters are automatically generated and do not necessarily reflect the full premium amount will be the consumer’s responsibility. Unfortunately, these confusing letters are throwing consumer’s into a panic generating phone calls to Covered California, Blue Shield, and insurance agents.

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Comparing Covered California EyeMed Vision Plans

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Covered California is giving individuals and families another option for vision insurance with the addition of EyeMed vision plans in 2016. The new EyeMed plans compete against the VSP Covered California vision plans added earlier in the year. Before families enroll in one of the vision plans they should remember that health insurance through Covered California also includes vision benefits for household members 18 years old and younger.

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Non-Tax Filers will lose Covered California subsidy

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Covered California will strip the health insurance subsidy from consumers who have not filed their federal taxes beginning on May 16, 2016. Word of the non-tax filer ineligibility for the Obamacare tax credits was released in a summary of updates to the Covered California online application software known as CalHEERS. The release notes for the CalHEERS 16.4 update state that enhancements to the application will include a way for consumers to attest that they have filed their taxes.

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Income questions top Covered California agent forum

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Consumers receive letters from Covered California stating that their estimated income doesn’t match with their most recent federal tax return. This has led many consumers to assume that Covered California can actually view a taxpayer’s federal return. Covered California can’t see a consumer’s federal tax return unless they send it to them to verify their income.

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Keeping track of Covered California clients

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Covered California is not very health insurance agent friendly when it comes to managing an agent’s book of business. Agents seem to be the last to know when Covered California or Medi-Cal makes changes to a client’s account and either strips their premium assistance or dumps them into Medi-Cal. Covered California has developed book of business and conditional eligibility reports for an agent’s clients enrolled in health plans through Covered California.

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Blue Shield online Covered California payments not applied for new members

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As of April 2016, when a consumer makes their first month’s payment for their Blue Shield health plan, the money is never applied to their account.

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