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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.


Proof of Income is Not Accepted. What Now?

By on | 5 Comments

Question: About a week prior to the deadline they gave me for my conditional 90-day acceptance, I mailed Covered California a monthly bank statement with the preface form they asked me to return, but I am not sure how/if this will truly prove my eventual 2014 income. What will happen if they still think this is not proof? Will they end my coverage completely, or give me another chance to help them determine what they need and re-establish my policy after a lapse?

Answer: No. Your coverage will not be ended. If your income verification is not acceptable, your premium assistance will be recalculated based on the best information available.

5 Comments

nkrieh —

I advise my clients to call Kaiser directly, or to go online to Kaiser directly to make initial binder payment, so that payment is taken right away, and with provided savable/printable PROOF of payment as available. I dissuade my clients from sending initial binder premium payment via a check as sent through the mail, as ‘issues’ are much more prone. Again, with my clients, I encourage payment with a live Kaiser customer service and/or billing representative, or with payment made online where proof of immediate payment is attainable.

Once initial payment is made, you solidify (legally bind) your coverage.

Kaiser IFP Membership 24/7 a day - (800) 464-4000

Kaiser IFP Membership Direct Pay: (888) 236-4490. 7am - 7am M-F.
7am - 3pm Sat/Sun

www.KP.org/payonline

Best to you.

CoveredCA is a disaster in my case. I applied with an agent in March and was accepted with the Kaiser plan I wanted. I was already a Kaiser member prior to this, but I enrolled for a better plan as my income and my husbands income was under the threshold for an Individual Plan for myself. I was enrolled in April for my new plan and made payment. I then called CoveredCA with an income change, which we are advised to do (still income under the threshold), and CoveredCA cancelled my policy with Kaiser, so I never received an invoice for May. My agent called Kaiser and they said to send my May payment to an address with my current Member Number on it. I also sent them all information received, from Kaiser and CoveredCA regarding my coverage that started in April. I was asked to submit tax returns and ID (I used our passports) which I faxed. I am still being asked to send these in now. I am now re-enrolled for June start date, but am still being asked for Tax and ID info, and they took off my husbands income information. He is retired but holds a part time job. So it appears like I am the only one with income. This is a disaster. I can’t call CoveredCA as then this starts the whole process again, and that was my big mistake, talking to them when that is what we are advised to do. I sent in a May payment to the address my agent got from Kaiser supervisor. It hasn’t been cashed yet. I now have a different payment amount, which is incorrect because CoveredCA has incorrectly entered my income information. I am thoroughly disgusted. Will this ever get straightened out?

Thanks Phil, I do have the new chart and numbers.

However, Covered California to re-assess her eligibility after application approval effectively a month earlier, when approved without conditions, and then to drop her from her health plan… how is that legal? It is not.

Michael, The new 2014 Federal Poverty Guidelines (chart available at https://www.cahba.com/PDF/2014%20FPL%20Charts.pdf) resets the 138% FPL threshold at $16,105 for a household of one, so your client is now eligible for Medi-Cal at $16,020. Apparently Covered California made the change of coverage abruptly and without prior notice in your example. I hope this is not the norm. If you can get a copy of the client letter of May 17th, I’d like to see a copy.

Phil.

Wish it were so. Covered California now in willful violation of California law.

My client applied for coverage with stated income of $16,020, for an initial plan effective date of April 1st, 2014. She was approved withOUT condition; with NO REQUEST for proof documents. She paid her premium binder payment to Anthem. She paid her May premium payment to Anthem. She just today received her June billing invoice from Anthem.

Covered California has disenrolled her from her health plan, and enrolled her into Medi-Cal! She has received no notice from Covered California (yet). She discovered this issue as she received materials from Medi-Cal about selecting a plan (geez Medi-Cal acts fast when you don’t need them…).

Called Covered California, and indeed a letter was issued on May 17th, three days ago (of course yet to be received in the mail by my client). This CovCal letter states my client has 30 days to appeal. Yet Covered California has already disenrolled her from her current Anthem plan, effective in 10 days, on May 31st (amazing!), and enrolled her into Medi-Cal for June 1st, 2014 (also giving her one day (May 31st) without coverage at all.

Turns out the income re-determination, which occurred on May 2nd, is now based upon eligibility of the NEW 2014 Federal Poverty Level (FPL) income threshold numbers. Way to go Covered California!

So Covered California has changed the game AFTER she has already applied, and after she was approved, and given a plan WITHOUT condition; a plan which only originally went into effect a month and half ago, on April 1st, 2014. What gives?

Wish it were so Phil.

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