Covered Ca: Removing or Changing a Policy

[MIM]

I'm not sure if this has already been covered but I'll ask it here for the sake of saving time.

I enrolled a client through Covered California with Blue Shield for his wife and him. The client wanted to remove his wife and put her through a plan OFF the exchange and still keep him on the policy. I called Blue Shield and they said they can do nothing to change it unless the client goes through Covered California to request the change. Is this really true ? How can he make that change effectively and still meet the deadline for the 31st. Wouldn't they try to keep both on and discourage a disenrollment ? Would it be better to just cancel the whole policy altogether and just re enroll him on a different plan ?

Any fast insight on this would be a tremendous help. Thanks!

MIM

 

[Quotebroker]

They are correct. If you enroll through CC, you must make changes through CC as well. File a change report

 

[MIM]

They are correct. If you enroll through CC, you must make changes through CC as well. File a change report

Ah! That's right, I remember seeing that option. Have you done it before ? Do you know if it takes long for it to respond or change ? Thank you for your speedy response!

MIM

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They are correct. If you enroll through CC, you must make changes through CC as well. File a change report

Update: I tried logging in to Covered California and when I go into the client's profile, it won't let me change or remove anything. Ugghh....

MIM

 

[Ron0]

Well,I think following rules and regulations is better.Its better that the client must go through Covered California to request the change...

 

[MIM]

Well,I think following rules and regulations is better.Its better that the client must go through Covered California to request the change...

I wish I could but I can't do that. Client's wife was absolutely adamant about leaving the exchange. I ended up signing her up with an off exchange carrier. I wonder what would happen if the client just stopped paying the premium if making a change through Covered California was not an option ? Client may get kicked off too but at this point I don't think they're too worried about that. Worse comes to worst, they'll just both go off exchange.

What a mess this whole thing is. I'm so mad.

MIM

 

[Quotebroker]

Well,I think following rules and regulations is better.Its better that the client must go through Covered California to request the change...

Obviously I don't mean to make changes willy nilly on your own. Inform the client of what must be done, then assist them in legally executing the change. But if we just tell every client "Call CoveredCA and wait in line for 2 hours to talk to someone who is less qualified than I am" then what do they need a broker for?

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Update: I tried logging in to Covered California and when I go into the client's profile, it won't let me change or remove anything. Ugghh....

MIM

It doesn't show the gold button "report a change" or the blue hyperlink in the bottom right "file a change report" ?

 

[MIM]

Obviously I don't mean to make changes willy nilly on your own. Inform the client of what must be done, then assist them in legally executing the change. But if we just tell every client "Call CoveredCA and wait in line for 2 hours to talk to someone who is less qualified than I am" then what do they need a broker for?

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It doesn't show the gold button "report a change" or the blue hyperlink in the bottom right "file a change report" ?

Update: I went back and looked for what you were pointing out. I think I found it and I was able to fix it. (I think. lol) But now, when I go back to the enrollment section of the client's file, it's saying that I need to choose a healthplan for the client that I just removed. Can I just leave it as it is, or do I need to do something else ? I've already selected a plan for her off exchange and signed her up and now she's happy. Thank you by the way for the feedback. It was a badly needed answer. lol... Super thanks!

Also, I have another client that I put through Health Net but he took so long in making the payment that the carrier ended up closing the file. Do I need to start a new application with Covered CA or just modify the one that already exists ?

I will say that writing off exchange is awesome. Thank you all for your contributions to this forum.

MIM

 

[Quotebroker]

Update: I went back and looked for what you were pointing out. I think I found it and I was able to fix it. (I think. lol) But now, when I go back to the enrollment section of the client's file, it's saying that I need to choose a healthplan for the client that I just removed. Can I just leave it as it is, or do I need to do something else ? I've already selected a plan for her off exchange and signed her up and now she's happy. Thank you by the way for the feedback. It was a badly needed answer. lol... Super thanks!

Also, I have another client that I put through Health Net but he took so long in making the payment that the carrier ended up closing the file. Do I need to start a new application with Covered CA or just modify the one that already exists ?

I will say that writing off exchange is awesome. Thank you all for your contributions to this forum.

MIM

If you want to just use the OffX plan, then use the "Terminate Participation" button in the same place you found the change report button

 

[MIM]

If you want to just use the OffX plan, then use the "Terminate Participation" button in the same place you found the change report button

Crud. Apparently I did not do it this way. The way I removed her was when you're looking through the app and you have the option of "edit", there is a box underneath the "edit" that says "remove". When you check this box it gives you two more boxes to choose from. I believe I picked the one that says "remove member" from policy (or something like that). So now it says "no" on the question on whether or not she wants coverage. But when I go to the end of the app, it's saying I need to select a coverage for her. I tried selecting terminate participation but on the dropbox it didn't have her name in it so I couldn't choose her. Am I ok at this point or do I need to re add her just for the sole purpose of "terminating" her ? Man, this thing is so much harder than it needs to be. Not sure of what to do at this point except maybe call in and that's a whole day ordeal if I even get through.

MIM

 

[ClientPro]

It may be too late for this warning but perhaps it will save your client some later grief....by removing one of 2 from an ON-HIX (exchange) plan, there could be 2 maybe 3 risk elements:
1) most medical networks of ALL carriers whether on or off HIX are limiting ACA plan acceptance regardless, until they're fully acclimated to the perceived reimbursement reductions;
2) ON-HIX plans are the only means of deriving subsidies. Eligibility for subsidies have been largely based upon JOINT tax return histories; with one less applicant and the vague enforcement rulings for 2014 estimated income eligibility criteria, there is a possible risk of subsidy REDUCTION, resulting in a 2015 over payment penalty AND an IRS payback requirement;
3) subsidies can not be applied to OFF HIX plans, and only upon ON-HIX plans per ACA rules, resulting in complexity of #2 above.

I've been consulting for several carrier members with their changes and various enrollment issues, numbering into the thousands and detect there are more than premium funding issues with folks making On to Off Exchange adjustments. There's usually a reason the grass is greener on the other side - more "fertilizer beneath the surface".... April Fool's Day will be a grand surprise when Californians realize their on or off plans aren't worth the exorbitant premiums being paid for them.