Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

How Long for Document Verification?

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Question: Only proof of citizenship was needed for my family - docs uploaded now 2 wks ago - when will verification of docs occur so that enrollment can occur? Thanks!

Answer: You are conditionally eligible now. What that means to you is you will have coverage on Jan. 1st. The conditional part is submitting the required verification documents within 90 days of the date of your application. I guarantee you that whatever you have submitted so far has not even been looked at. So don’t stress. You probably will not get any response to your submittal until well into January.

7 Comments

Fred, thank you. That’s enlightening. I didn’t indicate a lump sum payment on my taxes but it can see where it might have confused CC if they didn’t know what they were looking at. I am going to wait until Feb to call; their hold music is terrible ;-). None of it impacts my 2014 income anyway (i made a point of doing a Roth conversion Dec 2013 so I will not do one in 2014). They will probably wonder about that too, but in December I’ll have Medicare so I probably won’t have to explain it.

Lin, the notice that you received on approximately December 20th or 21st was NOT sent to you based on a review of your uploaded tax document. It is extremely unlikely that your income verification document has even been reviewed yet, even as of today.

The notice that you received referring to lump-sum payments was a generic notice sent to many applicants (not just you) who identified part of their income as “one-time-only” payments. This was a notice dated on or around 12/20/13, with a second paragraph that reads:

“At the time that you applied for insurance, you reported that someone in your household received a one-time payment or a “lump sum” payment as all or part of the annual household income. This could affect which program you are eligible for. In order to be sure that you and your household members are in the right program, we need to review your application.”

Apparently, Covered California became concerned that they may not have properly treated income amounts designated on the application as “one-time-only”. I don’t know how the application is presently worded or processed but back in October and November, any one-time-only income amounts were simply divided by 12 and added to the other income amounts to derive the applicant’s monthly income. This is fine if the “one-time-only” income was in fact a recurring annual payment, but not the right assumption for semi-annual payments or income that was truly a one-time payment that will not re-occur in 2014. When Covered CA noticed this problem, they realized they needed to re-contact some applicants for a clarification.

So Covered CA sent out a notice on or around 12/20 with their typically confusing language. It advises people to call “right away, so your health coverage can start on January 1, 2014.” In fact, all they really want is to make sure that they have the correct estimated 2014 income for you. That in turn has no impact on whether your coverage would start on 1/1/14, though it might affect the amount of your subsidy or cost-sharing reduction (or might even make someone eligible for Medi-Cal).

If you haven’t already done so, call when the phone lines are less jammed and explain the “one-time-only” income amounts on your application. Then reiterate the correct income estimate that you wish to furnish for 2014.

As for income verification, in all likelihood you won’t receive any notice until the 90-day period for furnishing proof has expired. At that point, keep a close watch on your Secure Mailbox on your Covered CA account.

Logically this “conditionally eligible” should refer only to the payment. I mean if someone is not eligible then he should pay back the subsidy then continue with full premium. I think it will be crazy to cancel a policy that started just because a certain income is not met and the subsidy changes or stops. The confusion starts from the fact that is not clear how you can take the subsidy at the end of the year rather than upfront. Although this option is written on the paper application on page 30.

Completed the enrollment with a CC operator on December 18 and I am conditionally eligible. The account on CC show that I need to send proof of income by March 10. But when I asked the CC operator if I need to send the documents immediately he did not answered clear. Just that I should get the bill from Blue Shied in 7 days and need to send proof. Therefore it seems to be 90 days but the CC operator kept it in a gray area. Just my assumption based on my experience so far.

Phil,

This response is pretty confusing to those of us who are still waiting to have our documents verified. It’s all well and good to say that we’re “conditionally eligible” and “will have coverage” on 1/1/14…but who is our insurer if we need to go to the doctor before verification is complete? What do we tell providers when submitting payment information?

so does this mean that i should be receiving an invoice from my provider anthem or be able to pay online, even if my documents are still pending approval?

That’s what I thought, but they reviewed my uploaded tax document yesterday. And sent me a secure email saying I had to call them immediately to complete the process (they mistakenly think my espp stock sales were lump sum payments). The letter said to call right away so I would still have coverage on Jan. 1st. well, I can’t get through on the phone no matter what I try. All I can do is hope they still cover me and I can call after the 1st when the phone lines hopefully won’t be so busy. I have APTC and CSR so I hope this doesn’t screw that up. I’d be happy to explain if I could only not get disconnected when I call.

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