Column 32 More on Deadlines

A recent survey said that over 50% of the populations does not know when open enrollment for individual health insurance ends.  Just to be clear, as it stands today, open enrollment ends March 31.  If you apply for coverage before Feb 15, coverage will be effective 3/1/2014.  If you apply between 2/15 and 3/15, it will be effective 4/1.  If you apply after March 15, coverage will be effective 5/1. 

These deadlines and the fact that system is inefficient at best make it all that more important to apply now.  The only reason to apply through the Exchange or Covered CA is if you think you will qualify for Advanced Premium Tax Credit or subsidy.  Because in applying through the Exchange you subject yourself to an additional layer of bureaucracy that is inefficient at best. 

The most recent example of this problem is seen in a case at my office.   I had an individual who had enrolled directly through Covered CA call our office.  She had enrolled in a Blue Shield plan, not understanding that it was an EPO (Exclusive Provider Organization).  She contacted Covered CA with a request to change plans.  They told her they could not help her, she had to contact an agent.

As this was a first for our office I inquired as to the procedure.  The law is very explicit in allowing such a change during the initial open enrollment phase. I received 3 different answers from 3 different sources at Covered CA, one of which was the following email from the so called  "agent hotline".

"Thank you for contacting Covered CA. The only way to change a plan once it has been chosen is for the client to call the individual line at 888-975-1142 - the individual representatives have the access & ability to make the change."

One of the other instructions is :

1) Go into application and terminate the application.

2) Enter the cancellation date of the policy, which can be a future date. 

3) Revise the application and resubmit with an effective date following the cancellation date of step 2. 

4) Wait for carrier to process application

Thanks to our friends at Covered Shasta I was directed to a job aid that was provided to CEC's in November.  I reviewed my job aids provided by Covered CA to agents and was unable to locate this.  Further, it instructs us to provide a carrier cancellation code that my carriers are unable to provide at the last request. Hmmmm.

 

 

 

What is Enhanced Silver Level of Benefits and how does one qualify? 

 

If  you access  your insurance under Covered California and have income between 138-300% of Federal Poverty Level, not only are you eligible for Advanced Premium Tax Credit or Subsidy, you may be eligible for Enhanced Benefits also known as Cost Sharing Reductions.  The following chart shows the income and benefit levels for a single individual. This is what we call the "sweet spot" because often the costs are not much more than the bronze plan at these levels, yet the benefit levels are much more generous.

 

 

 

 

 

 

 

 

Are you insured by Anthem Blue Cross under the individual plans and have questions?  Well Santa came, albeit a little late. Check out this link:  http://www.anthem.com/wps/portal/ca/popcontent?content_path=provider/f5/s3/t0/pw_e211249.htm&label=#P13_870

Here you can print a temporary ID card, get instructions for your pharmacist on how to file a claim, make initial payments.

While this column has been heavily discussing the new health care world, it's important to understand that there are many other areas of insurance that effect our daily lives.  Personal life insurance is one very important issue.  Did you know there are at least 3 parties to the life insurance contract? They are Insured, owner and beneficiary.  Structuring your life insurance properly is an important issue.  With the stroke of a pen (or taps on a keyboard) you have likely created an estate worth thousands or even hundreds of thousands of dollars.  Be careful and attentive to each of these provisions.  I will write more on this topic soon.

 

*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.