Agent Briefing – News from Covered California
September 10, 2015
New This Week: Pre-Termination Notice – This notice is a follow up request to resubmit eligibility documentation to Covered California. Members that receive this notice must submit Lawful Presence/Citizenship and/or Social Security documents to continue with health coverage or financial assistance through Covered California. Consumers that receive this notice must provide Covered California with appropriate documentation by September 30, 2015 or risk coverage termination.
Sample Pre-Termination Notice
Your health insurance will end on September 30, 2015
Contact us right away!
<Date> Case Number <XXXXXX>
Dear {HH_FIRST_NAME} {HH_LAST_NAME},
Your health insurance will end on September 30, 2015, if you don’t contact us right away. You received a letter from Covered California in the last 45 days requesting that you send us documents by August 31, 2015, for the individuals listed below to show that you or other members of your household are eligible to continue health insurance and/or financial assistance through Covered California.
| We need documents from the following individual(s) where a box is checked below: Citizenship/ Lawful Presence | Social Security Number | ||
| {FIRST_NAME} {LAST_NAME} | ⧠ | ⧠ | |
| {FIRST_NAME} {LAST_NAME} | ⧠ | ⧠ | |
| {FIRST_NAME} {LAST_NAME} | ⧠ | ⧠ | |
What Happens Next?
The individuals listed above will no longer qualify for health insurance and their current health coverage will end on September 30, 2015. Other members in your household will be able to keep their current health plan.
Your health insurance company will send the individuals listed above a letter that their health coverage will end on September 30, 2015.
If you received premium tax credits, you may have to repay the Internal Revenue Service (IRS) some or all of the tax credits you received when you file your taxes in 2016. You may also have to pay a tax penalty if you stay uninsured and do not qualify for an exemption.
I Do Not Want to Lose My Coverage. What Are My Options?
Covered California does not want you to lose your coverage if you or members of your household can show that you are eligible for Covered California. If you have already submitted documents or if you are having trouble submitting documents, you have options.
1: Call our Service Center at 1-800-300-1506 to speak with a representative. You can call Monday through Friday 8 a.m. to 6 p.m. and Saturdays 8 a.m. to 5 p.m. The call is free. For TTY, call 1-888-889-4500.
2: File an appeal. If you think we made a mistake or you don’t agree with our decision, you can appeal. You have 90 days from the date of the eligibility decision to file an appeal. If you appeal and we agree with you, we may change our decision. If we change our decision, your family members’ coverage may also change, even if they do not file their own appeal. Appeal hearings will be conducted by telephone, video conference, or in person. You may choose to represent yourself, or be represented by an attorney or another representative.
You have the right to appeal any of the following decisions:
1) You did not qualify for a Covered California health plan or premium assistance.
2) You did not qualify for Medi-Cal.
3) The amount of premium assistance (federal tax credits to help lower your monthly premium) you qualified for is not correct.
4) The level of cost-sharing reductions (help paying your co-payments and deductibles) that you qualify for is not correct.
5) You did not get a decision about your application in a timely manner. (More than 10 days after receipt of a complete application if you qualified for Covered California or more than 45 days if you qualified for Medi-Cal).
You may request to stay in your Covered California health plan with your current level of premium assistance while your appeal is pending. This is called “continued enrollment”. You must keep paying your share of premium on time to qualify for continued enrollment. If you request continued enrollment, please do not send your appeal by mail. Instead, call 1 (855)795-0634 or use fax or email.
You can request an appeal in any of the following ways:
Go to www.CoveredCA.com to download and print a “Request for a State Fair Hearing to Appeal a Covered California Eligibility Determination” form.
Fax your appeal to the State Hearings Division at: (916) 651-2789
Mail your appeal to:
CA Department of Social Services
Attn: ACA Bureau
P.O. Box 944243
Mail Station 9-17-37
Sacramento, California 94244-2430
Email your appeal to: SHDACABureau@DSS.CA.gov (please do not email private information such as your Social Security Number).
Request an appeal in person at your County Welfare Department.
Call the State Hearings Division and submit your appeal over the phone: 1 (855) 795-0634.
If you have an immediate need for health services and a delay could seriously jeopardize your health, you can ask for an expedited appeal by calling 1 (855) 795-0634.
An appeal decision for you or other members of your household may result in a change in your eligibility or the eligibility of other members of your household. The change in eligibility may result in a redetermination of eligibility for all household members.
For free local assistance with appeals, please call the Health Consumer Alliance: 1 (888) 804-3536.
What If I Am Having Trouble Getting My Documents?
We know it can take a long time to get copies of certain documents. Please visit coveredca.com to see a full list of acceptable documents you can submit to us.
What If I Get Renewal Notice From Covered California?
You may get a notice from Covered California about renewing your current health insurance. The individuals listed above will only be able to renew their health insurance for 2016 if they give us the documents we are requesting. Please call the Service Center right away so that the individuals listed above can renew their coverage.
Can I Wait Until Open Enrollment To Sign Up Again?
Yes. The next open enrollment period for Covered California runs from November 1, 2015 through January 31, 2016. Coverage will begin January 1, 2016 if you renew or apply again and select a plan by December 15, 2015.
If your coverage ends on September 30, 2015 and you did not get us your documents, you will have to apply again during open enrollment. You will not be able to qualify for coverage in 2016 unless you give us the documents that we are now asking for. Please call us if you need help getting your documents.
Download -> Covered California Sample Pre-Termination Notice