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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.


Choosing Wrong Plan a Qualifying Event?

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Question: We were approved for Covered California but I chose the wrong health insurance plan. It has not yet take effect (it takes effect in 5 days). Can I change the health plan, or should I terminate Covered California and start over again? Thank you!

Answer Don't terminate your current coverage. Open enrollment for 2014 has ended. You cannot change your plan unless you have a qualifying event which makes you eligible for a special enrollment period. Making the wrong plan selection is not a qualifying event. However, if you can make the case that you made the wrong choice "as a result of an error, misrepresentation, or inaction by an insurer or agent", then Covered California may grant you an exception.

4 Comments

We signed up for the kaiser enhanced silver 94 but we are not being billed correctly. Our premium is $227 (I thought it would be $271?). We just got out first bill for services and so etching is DEFINITELY not right. Under the silver enhanced we are supposed to pay a co-pay of $3 for labs, but we just got a bill for lab work for $109! The $109 is what is due AFTER the insurance paid their part. Am I missing something?

To Diana. Yes, if you experience a special enrollment event and choose a plan, you can switch plans within that 60 day time period as long as the plan has not been effectuated yet. Covered Calif. policy reads ” You are eligible to change plans more than once during the special enrollment period if you have not already effectuated a plan during special enrollment or if you experience another qualifying life event.”

A group receives their renewal with a substantial increase in premium. They decide to drop the group plan and send all employees to IFP market. Blue Shield says all employees but the owner will qualify for a special enrollment, but the owner of the group policy would not qualify for a IFP plan because it is a voluntary termination of group coverage. This question is of course aimed at all the Mom and Pop small groups. What say you? Is it lawful for the carriers to deny IFP coverage to employers who term their group plans?

Whoever answered this question, consider. If their policy is effective June 1, they, of necessity, had a ‘qualifying event’. The question remains, if their qualifying event allowed them to enroll at June 1, they should be able to correct this. Is there no allowance for errors??????

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