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Covered California Q&A

Covered California and Obamacare 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 Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Can Loophole Delay ACA Compliance?

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Question: Cigna (CA) tells me that I can keep my current plan through 2014. Doesn’t everyone have to change to Obamacare on January 1, 2014?

Answer: There is currently a loophole in the ACA that enables health insurers to extend existing policies for nearly all of 2014, thereby avoiding changes under the healthcare law. In california, some carriers, like Cigna, who are not included in the Exchange, are providing individual and small group clients an option to change their policy date to December, 2013. If you accept this option, you will keep your current level of coverage (at a new December 2013 rate) through November 30, 2014. The potential benefits are to lock in a new December 2013 premium through November 30, 2014, a premium that could be less than a 2014 ACA-compliant plan. When coverage comes up for renewal in November 2014, the plan will be closed. The loophole could close because carriers participating in Covered California, such as Blue Shield, Kaiser and Anthem Blue Cross, are lobbying state lawmakers to require individual policies to comply with the federal law by Jan. 1, 2014.


“Doesn’t everyone have to change to Obamacare”

Obamacare is not a health plan like Medicare is a health plan. Obamacare is a pseudonym for the PPACA. Each person must choose their own qualified health plan or face IRS tax penalties.

“does that policy of pre-exsiting exclusions become obsolete under the Affordable Care Act as of March 2013?”

Nothing becomes “obsolete” under the PPACA. Certain conditions of coverage will eventually terminate under most plans on January 1, 2014. A “grandfathered” group health plan that does not undergo a “material change” in coverage can continue under its current set of exclusions until 2016.

“What if a pre-existing condition wasn’t an issue for the 6 month period prior to coverage of the insurance?”

If you had “creditable coverage” under a former employer’s group health plan and went to work for a new employer within 63 days, then you have certain rights to coverage under the new employer’s health plan as far as preexisting conditions are concerned. You must be given credit toward any period of exclusion for your length of participation/service with the former employer.

“Would an individual have to contest the policy”

You have no standing to “contest the policy.” But if you believe you are being denied benefits unfairly or are being discriminated against, you may complain to the US Dept of Labor, Employee Benefits Security Administration. There are “local” offices in a number of regions around the US. Contact the one closest to your location.

If an individual has a new job with a health care plan that has a “pre-existing” clause, does that policy of pre-exsiting exclusions become obsolete under the Affordable Care Act as of March 2013? What if a pre-existing condition wasn’t an issue for the 6 month period prior to coverage of the insurance? Would an individual have to contest the policy to become covered as any other individual? Who or where would they address their issue?

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