Open Enrollment and Special Enrollment

Covered California has said they will allow extended enrollment through 2/22/15 for certain scenarios.

To take advantage of the extra time, they must have been, and be, working with a certified insurance agent, enrollment counselor or county eligibility worker.

After this Open Enrollment window closes, only Qualifying Events (or Special Enrollment Periods) allow consumers to change plans or enroll in a new plan.

EXAMPLE OF QUALIFYING LIFE EVENTS FOR SPECIAL ENROLLMENT:

  • Getting married or entering into a domestic partnership.
  • Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
  • Change in place of residency, which allows a consumer to gain access to new Covered California health insurance plans. This includes moving to California from another state. This also applies to individuals who are released from jail or prison.
  • Losing health coverage. For example, consumers are no longer eligible for Medi-Cal, or they lose health coverage through their job.
  • Income changes so much that a consumer becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.
  • Becoming citizens, national or lawfully present individuals. This event applies only to people who were not previously citizens, nationals or lawfully present.
  • The consumer’s enrollment was wrong, due to the misconduct or misrepresentation of their health insurance company, Covered California or a non-Covered California entity (such as a Certified Enrollment Counselor).
  • Being a member of a federally recognized American Indian or Alaska Native tribe. A consumer in this category may enroll in health insurance or change health insurance plan once a month even if the open enrollment period is over.
  • Covered California can also determine, on a case-by-case basis, that the consumer experienced an exceptional circumstance, which could allow for a special enrollment period.

Eligible consumers with a low income, who qualify, can apply for Medi-Cal anytime throughout the year.

For more information, you can view the Covered California link below.  To enroll in a plan and explore your options, contact Steve Downey, or any Covered California Certified Insurance Agent.

http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/

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The Health Care Law’s Effect on You

Nearly everyone is affected by the Affordable Care Act and will need to do something new when filing their taxes this year. The chart available at IRS.gov/aca will help you better understand how the health care law affects you and everyone on your return.

To help navigate these changes, taxpayers and their tax professionals should consider filing returns electronically. Using tax preparation software is the best and simplest way to file a complete and accurate tax return as it guides individuals and tax preparers through the process and does all the math. There are a variety of electronic filing options including free volunteer assistance, IRS Free File for taxpayers who qualify, commercial software, and professional assistance.

And remember, Open Enrollment ends on February 15th, 2015!

California emphasizes ObamaCare penalty

Extract from Article Written By Elise Viebeck:

California’s health insurance exchange is reminding consumers that they will face a penalty under ObamaCare for remaining without coverage, a messaging tool to boost enrollment that other marketplaces have hesitated to embrace.

Covered California, one of the nation’s most successful exchanges, made no effort to downplay the individual mandate penalties that took effect last year and are set to rise in 2015. The marketplace is encouraging consumers to pick plans by Thursday, the deadline for insurance that kicks in Feb. 1.

“It’s important that consumers understand now that the cost of remaining uninsured is rising,” Covered California Executive Director Peter V. Lee said in a statement Tuesday. “This year, a family of four earning $70,000 a year could pay close to $1,000 in their taxes if they remain uninsured in 2015.”

http://bit.ly/1FXiFEb

How to Write Irresistible Blog Posts

Using CoSchedule helps keep social media interactions and postings more organized for small businesses.  We found their current blog post interesting… and we are guessing it will be helpful for you and your small business, as well!

Here’s the link:

http://bit.ly/1rSBouu

Hope you had a nice Thanksgiving holiday.  Remember the ACA Open Enrollment period ends Feb. 15th, 2015, so be sure to apply by the 15th of the prior month for coverage 1st of the next month.

Covered CA – Consumer Income Reconciliation Notice

Covered California will be sending a notice next week to health plan enrollees that received APTC, or “premium assistance,” encouraging them to report any changes in income or household size since enrolling in a Covered California health plan.

Enrollees who received premium assistance this year will need to file taxes for 2014. When they file, the IRS will check to see if the amount of income they reported to Covered California is the same as the amount of income they actually made. The IRS will also check to see if their family size is the same as when they applied. The IRS will compare, or “reconcile,” the amount of premium assistance they qualify for based on their actual income and family size reported on their tax return with the premium assistance they received during the taxable year.

Enrollees who experienced a change in income or household size but have not reported this information to Covered California are at risk of having to pay more at tax time. If needed, Covered California can work with these enrollees to reduce their current premium assistance to minimize this consequence.

Consumers have to Clarify their Lawful Presence in CA

Dear Colleagues and Interested Parties:

FOR IMMEDIATE RELEASE

Sept. 4, 2014

COVERED CALIFORNIA REACHES OUT TO
THOUSANDS OF CONSUMERS WHO HAVE LIMITED TIME TO CLARIFY THEIR LAWFUL PRESENCE IN CALIFORNIA

Agents, Counselors and Community Organizations Will Help Educate Enrollees That Citizenship and Immigration Documents
Must Be Submitted, or the Consumers Risk Losing Coverage

SACRAMENTO, Calif. — Covered California is contacting about 98,000 families that must resolve eligibility inconsistencies in their 2014 enrollment documents.

The consumers will need to submit documents showing they are lawfully present in the United States as U.S. citizens, U.S. nationals or individuals with eligible immigration status, in order to continue their health insurance through Covered California. Notices are being mailed and emailed to consumers beginning this week. If proper proof is not provided by Sept. 30, 2014, these individuals risk termination of health coverage.

“We want to clear these inconsistencies so that our consumers can have a smoother renewal process without any interruption in their coverage,” said Covered California Executive Director Peter V. Lee. “We’re implementing a multi-touch, multi-channel outreach approach to notify individuals who risk losing coverage.”

Covered California has been working to clear inconsistencies. To date, more than 700,000 documents have been verified and processed.

Documents submitted by consumers will be treated confidentially and will be used only to determine the consumers’ eligibility for health insurance programs and will not be used for immigration enforcement.

Lee said some consumers may have previously provided Covered California the required documents, but the agency could not reconcile the information to verify citizenship or immigration status. For example, some documents were illegible, and in some cases two pieces of proof were needed, but only one document was sent, so the agency is requesting the documents be sent again.

The notices will provide consumers with a list of documents they can send to prove their lawful presence. The notices will be delivered in English and Spanish, and help is also available in other languages.

Consumers also will be instructed on how to upload the documents to their account, send them via U.S. mail or fax them to (888) 329-3700. Additionally, thousands of partners, including Covered California Certified Insurance Agents, Certified Enrollment Counselors, Service Center representatives and county eligibility workers, will be available to help consumers submit the necessary documentation.

Lee stressed that consumers should act quickly to submit the requested documents.

“If we do not get your documents, Covered California must cancel your health insurance, along with any federal tax credit you may be receiving that lowers your monthly premiums,” Lee said. “If you have received tax credits, and your health insurance is canceled, you may have to repay those tax credits. If your health insurance is canceled, you may also have to pay a tax penalty.”

Qualifying documents that prove lawful presence include a U.S. passport; a certificate of naturalization (N-550/N-570); a certificate of citizenship (N-560/N-561); a U.S. public birth certificate; a driver’s license issued by a U.S. state or territory; an identification card issued by the federal, state or local government; a school identification card; a foreign passport; and a green card. A complete list will be offered at CoveredCA.com.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans. Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit http://www.CoveredCA.com.

Covered CA Plans to Expand Dental Offerings

Dear Colleagues and Interested Parties:

FOR IMMEDIATE RELEASE
Media Line: (916) 205-8403
Aug. 20, 2014

COVERED CALIFORNIA PLANS TO OFFER EXPANDED DENTAL SERVICES FOR CHILDREN AND NEW COVERAGE FOR ADULTS

Pediatric Dental Care Embedded in Standard Plans for 2015; Also New in 2015 Are Optional Family Dental Plans That Will Offer Coverage for Adults

SACRAMENTO, Calif. — Covered California is offering new family dental plans to consumers who enroll in health insurance coverage in 2015. Additionally, all individual health insurance plans sold through the Covered California exchange will include pediatric dental benefits for members younger than 19.

“This is great news for families and children, because all children enrolled in Covered California will have dental coverage embedded in their comprehensive health plan,” Covered California Executive Director Peter V. Lee said. “They will be getting better coverage and more for their money.”
Additionally, Lee said, the family dental plan will offer adults the option of receiving dental coverage outside the general health plans at an additional cost. Some consumers also may be drawn to family dental plans if a provider they prefer for their child is not offered in their embedded coverage.

The optional stand-alone family dental plans, which offer coverage for adults, will not be available at the beginning of open enrollment, which starts Nov. 15, but are planned to be added in early 2015. Covered California will offer both dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans, giving consumers a choice in the type of plan that will work best for them. There is no financial assistance available for the optional adult dental benefits.
Lee emphasized that there is no requirement to enroll children in a family dental plan. The family dental plan is optional and is primarily intended to offer affordable dental coverage to adults that was not available in 2014. Families should consider that adding their children to a family dental plan will result in an extra cost for the same dental services they already receive in their standard health insurance plan. The most likely reason to enroll a child in the family dental plan is if a dental provider they prefer for their child is not offered through their embedded coverage.

Covered California is notifying enrollees to explain the availability of pediatric dental benefits in its health insurance plans, as well as to explain the newly available family dental plans that include dental benefits for adults.

Below is a list of the pediatric dental coverage embedded with Covered California’s health insurance plans.

Health Insurance Plan Selected
Pediatric Dental Coverage
Embedded into Health Insurance Plan
Anthem Blue Cross of California
Anthem Blue Cross
Blue Shield of California
Blue Shield of California
Chinese Community Health Plan
Delta Dental of California
Health Net
Dental Benefit Providers
Kaiser Permanente
Delta Dental of California
L.A. Care Health Plan
Liberty Dental Plan
Molina Healthcare
California Dental Network
Sharp Health Plan
Access Dental Plan
Valley Health Plan
Liberty Dental Plan
Western Health Advantage
Premier Access

Family dental plans are offered from the companies listed below.

Optional Family Dental Plans
Access Dental Plan
Anthem Blue Cross
Blue Shield of California
Delta Dental of California
Dental Health Services
Premier Access

A booklet containing more information about the new family dental plans is available online at http://www.CoveredCA.com/coverage-basics/plans/.

About Covered California

Covered California is the state’s marketplace for the federal Patient Protection and Affordable Care Act. Covered California, in partnership with the California Department of Health Care Services, was charged with creating a new health insurance marketplace in which individuals and small businesses can get access to affordable health insurance plans.

Covered California helps individuals determine whether they are eligible for premium assistance that is available on a sliding-scale basis to reduce insurance costs or whether they are eligible for low-cost or no-cost Medi-Cal. Consumers can then compare health insurance plans and choose the plan that works best for their health needs and budget. Small businesses can purchase competitively priced health insurance plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits.

Covered California is an independent part of the state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and the Legislature. For more information about Covered California, please visit http://www.CoveredCA.com.

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Covered CA Notice sent to (some) Clients

From COVERED CA:

Notices with Incorrect Open Enrollment Dates

In the past two weeks, about 11,000 Denial of Coverage notices were generated and sent to consumers with the incorrect Open Enrollment dates for the Individual Marketplace. These notices were sent to consumers that applied outside of Covered California’s Open Enrollment period.  Although the dates indicated were correct at the time the notices were sent, a change in the law resulted in a change to the Open Enrollment period indicated.

The incorrect dates on the notice were October 15, 2014 through December 7, 2014. The 2015 Open Enrollment period is November 15, 2014 to February 15, 2015.

Please [be aware if you were] affected by this notice [and take note of] the new Open Enrollment dates. Be sure to also check whether [you] qualify for Covered California’s Special Enrollment Period.

If eligible, you can call [today for questions about enrolling in this special enrollment period].

[If you] are not eligible for Covered California’s Special Enrollment Period, [you] can apply during Open Enrollment this fall for coverage beginning January 1, 2015.

Changes in Circumstances can affect your Premium Tax Credit

Excellent reminder from the IRS re: Premium Tax Credits:         

If you receive advance payment of the premium tax credit in 2014 it is important that you report changes in circumstances, such as changes in your income or family size, to your Health Insurance Marketplace.

Most people already have insurance and they won’t have to do anything new. If you are looking for health insurance, you may be able to get it through the Health Insurance Marketplace and you may qualify for the premium tax credit.  You can “get it now” as an advance payment or you can “get it later” when you file your tax return.

Advance payments of the premium tax credit provide financial assistance to help you pay for the insurance you buy through the Health Insurance Marketplace. Having at least some of your credit paid in advance directly to your insurance company will reduce the out-of-pocket cost of the health insurance premiums you’ll pay each month.

If you decide to get the credit in advance, it’s important to report any changes in your income or family size to the Marketplace throughout the year. Reporting these changes will help you get the proper type and amount of financial assistance so you can avoid getting too much or too little in advance.

The government makes advance payments of the credit based on an estimate of the credit that you will claim on your tax return when you file in 2015. If you report changes in your income or family size to the Marketplace when they happen in 2014, the advance payments will more closely match the credit amount on your 2014 federal tax return.  This will help you avoid getting a smaller refund than you expected or even owing money that you did not expect to owe.

More Information

Find out more about the premium tax credit, as well as other tax-related provisions of the health care law at www.irs.gov/aca