Column 28- Covered CA payment options-Revised

I believe the saying is "nothing is so constant as change". Here we go again with a new procedure for paying Anthem for Covered CA applications. The reason I emphasize Anthem is that it is my understanding from most agents and brokers  that they are the preferred carrier since they have a PPO (Preferred Provider Organization) rather than an EPO (Exclusive Provider Organization).  In addition, Anthem premiums tend to be less.

Initial advice was to send in premium payment referencing your Covered CA case number.  We are now told that this is NOT the procedure. Instead clients are told to wait for their payment notices, which are going out daily.  

The client will receive a letter from Anthem.  This letter will explain what needs to be done to ensure proper payment gets made and that they are enrolled in their new health plan. The letter offers a variety of options for paying their first month's premium, including bank draft, check, money order, eCheck or credit card. It also gives a variety of ways to make payment like signing into a secure payment page or sending in a check or money order. Payments can be made on the phone at Anthem Service Center/ Customer Support is 800-333-0912.

Note the deadline for payment has been extended to 1/10/2014 and the phones are open M-F and Saturdays in January  8 am to 4 pm.

The link to the online payment portal is listed below, but we are asked to advise on-exchange clients to wait until they receive the Anthem  letter before making a payment on the portal. This should ensure a successful matchup of payment and application. This payment portal doesn't apply for off-exchange clients who apply online, as the initial payment is part of the off-exchange online application process.

For coverage ON EXCHANGE use: https://shop.anthem.com/sales/eox/payment/enroll /landing/ca.  Important note: Be sure to include the application ID, which can be found on the letter. The application ID is located on the top left hand side of the letter, underneath Applicant Name. 

If mailing in a paper check is preferred, it is requested that you include a copy of the Anthem letter with the check and write the Application ID on the check or money order.  Mail it to: Anthem Blue Cross P.O. Box 9041 Oxnard, CA 93031-9041.

So what if you mailed it in under the original instructions?  If you have a proof of mailing, include a copy of that with your check number, date and amount and return with the copy of the letter in the instructions.  If you have no proof of mailing you may call the Anthem Customer Service center to see if your check is received.  If you have adequate cash flow to pay again per the instructions, it would simply mean you are pre-paid for February when they finally track down your check. 

While I understand this is a hassle for a lot of folks, it's important to remember that these APTC (Advance Premium Tax Credits or subsidies) are often big dollars and are likely worth the extra effort. 

When folks are enrolling I have found there is a lot of confusion about the question that asks if you have Affordable Minimum Value insurance.  This was mentioned in earlier column, but likely got lost in the shuffle and is very important.  Your personal definition of "affordable" is likely different than the law. 

The law states that if an employee is offered "minimum value" coverage and the employee share of premium for EMPLOYEE ONLY coverage does not exceed 9.5% of the employee's W-2 income with that employer, then the employee and dependents are not eligible for subsidies on the Exchange.  I have had calls from employees of our small employers expecting that they could go to the Exchange because the employer pays none of the premium for dependents.  It is my understanding that this is not true.  I am not sure that the Covered CA folks are explaining this as well as it could be.  Or perhaps an employee is enrolling online alone and doesn't understand that restriction. 

I am concerned that if this is answered incorrectly and a subsidy granted, the individual could end up with a big tax bill at the end of 2014 to repay the APTC (Advance Premium Tax Credit).  

 

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.