California Health News

Covered California Report A Change function disabled

Kevin Knauss

Covered California disables the Report a Change function until November 4, 2014.

Covered California will be updating the enrollment software between October 13th and November 4th, 2014. This update disables the Report a Change function preventing consumers from adding a family member through either birth or adoption. Covered California has published escalation procedures for Certified Insurance Agents and Certified Enrollment Counselors to use when they need to add a baby or activate a health. A side effect of the upgrade, that Covered California hopes will be temporary, is the inability for new enrollees to purchase a health plan.

Escalation procedures for reporting a change

These escalation procedures should only be necessary through November 4th when Covered California completes the second part of their renewal process software upgrade. The following are instructions from Covered California. The file can be downloaded at the end of post.

IMPORTANT NOTICE

October 14, 2014

RE: Covered California Online Application, Report a Change for 2014 Coverage during October 13 through November 3, 2014 ONLY

Dear Covered California Certified Insurance Agents (CIAs), Certified Enrollment Counselors (CECs), and Plan-Based Enrollers (PBEs):

Covered California will start to send notices this week to all households with at least one member enrolled, or pending enrollment, in a Covered California Health Plan informing them of the Renewal process beginning in mid-October. However, between Covered California Online Application Release 8 .0 (10/13/14) and Release 9.0 (scheduled tentatively for 11/3/14), the Report a Change functionality for benefit year 2014 will not be available in the online application.

Covered California is providing this alternate procedure as a temporary process to assist consumers who need to report changes on their account for the 2014 coverage year. You are to use this process from October 13 November 3, 2014 only.

Call to Action:

Consumers who ARE in Renewal Mode (Renew is displayed on the Individual Home Page):

o Want to report changes effective for the 2014 coverage year, the Report a Change functionality in the online application will NOT be available. Consumers, Certified Enrollment Representatives, Help Desks/Lines, and the Covered California Service Center will not see the Report a Change option on these consumers accounts.

o Read below to proceed with the alternate procedure to report a change. Note that each procedure is different based on your Certified Enrollment Representative type (CEC, PBE, or CIA).

o Do not select Renew if the required change to the account is either of these changes:

Consumers who ARE NOT in Renewal Mode (e.g. plan participation was terminated but application was not withdrawn):

o Want to report changes effective for the 2014 coverage year, the Report a Change functionality in the online application will be available.

o Ask the consumer if they have changes to make for the 2014 coverage.

Note: If the consumer has an access to care issue, is trying to add a baby, or otherwise needs the change to be effective before January 2015, either contact the CEC/PBE Help Line or the Pinnacle Agent Service Center for assistance. You may also refer consumers to the Covered California Service Center at 1-800-300-1506 Monday through Friday, 8 a.m. to 8 p.m., and Saturdays, 8 a.m. to 6 p.m.

Report A Change Alternate Procedure for Consumers in Renewal Mode ONLY:

This procedure applies to consumers who are in Renewal Mode but want to make changes to their 2014 coverage during October 13 November 3, 2014 only.

Types of Changes Reported:

  1. Access to care*
  2. Adding a newborn baby or an adopted child*
  3. Address change
  4. Add a Member (marriage or dependent)
  5. Remove a Member
  6. Income / Adjust APTC / Tax related
  7. Loss/Receipt of Minimum Essential Coverage (MEC) Medicare/Disability
  8. Name, Social Security Number, Date of Birth Change

*Any changes reported for these two areas, 1) access to care and/or 2) adding a baby or an adopted child, require the Certified Enrollment Representative to follow the escalation protocol below:

Alternate Procedure for Certified Insurance Agents (CIAs)

During October 13 November 3, 2014, CIAs assisting consumers in renewal mode with changes to report to their 2014 coverage shall:

Document all calls and the changes requested

o For changes #1 2 (as identified above) requiring escalation:

  1. Call the Pinnacle Agent Service Center at 1-877-453-9198.
  2. Pinnacle Service Center Representative will document all details of the requested change and escalate to Covered California.
  3. The requested change will be processed within one (1) month.
  4. The Pinnacle Service Center Representative will notify the CIA that the change was processed by Covered California.
  5. When adding a newborn baby or an adopted child to the coverage, please note the added babys or childs coverage will not begin immediately but may be retroactively applied. Therefore, the consumer may be required to pay for the babys or childs medical bills out of pocket and request a reimbursement from the health plan after the coverage begins.
  6. Pinnacle will Service Center communicate the outcome to the CIA so the CIA can notify the consumer once the change has been made.

o For changes #3 8 (as identified above) do not require escalation:

  1. CIAs should document all consumer changes that do not require escalation.
  2. CIAs should let the consumers know that their changes will not be entered until November 4, 2014 because of the system updates to the Covered California online application system from 10/13/14 through 11/3/14.
  3. On November 4, 2014 when the Covered California Online Application has been updated, CIAs will process the requested changes (#3 8) following the standard Report A Change functionality.

Alternate Procedure for Certified Enrollment Counselors (CECs) and Plan-Based Enrollers (PBEs)

During October 13 November 3, 2014, CECs and PBEs assisting consumer in renewal mode with changes to report to their 2014 coverage shall:

Document all calls and the changes requested

o For changes #1 2 (as identified above) require escalation:

o For changes #3 8 (as identified above) do not require escalation:

On November 4, 2014 when the Covered California Online Application has been updated, CECs/PBEs can process consumer requested changes following the standard Report A Change functionality after CECs/PBEs completes the consumer renewal process.

NOTE: In addition to assisting consumers via these alternate procedures, Certified Enrollment Representatives may also refer consumers to the Covered California Service Center at 1-800-300-1506 or 1-888-889-4500 (1-888-TTY-4500). The Service Center is open Monday through Friday from 8:00 a.m. to 8:00 p.m. and Saturdays from 8 a.m. to 6 p.m. for assistance with these changes.

For additional information or questions, please contact your help desk listed below:

Thank you,

Covered California

Enrollment Error Code: 000

If you receive an Error Code: 000 when you are trying to confirm the purchase of a new members health plan selection, you will not be able to go forward. You need to call the CC call center and open a fix-it ticket.