- What changes are coming to health care?
- What is Covered California?
- Who represents Covered California?
- If somebody approaches me about Covered California, how can I trust them?
- What information do I need to provide once I'm ready to enroll?
- What is the deadline to enroll?
- Who do I pay for health insurance I get through Covered California?
- How do I report suspected fraud to Covered California?
- Help! I think I was just scammed! What do I do?
Californians can now shop for new, affordable health insurance options through Covered California™ and in the individual market. Under new rules, health insurance companies cannot exclude applicants or change rates due to preexisting conditions. New coverage is available beginning Jan. 1, 2014, including subsidized coverage that is available only through Covered California. Additionally, as of Jan. 1, 2014, more individuals are eligible for free or low-cost health insurance through Medi-Cal. The new year also starts the requirement for most individuals to carry health insurance, and there are new rules for all health insurers in the individual and small-group markets.
Seniors in Medicare do not need to do anything. They will remain enrolled in their current coverage. Similarly, most individuals who receive health insurance through their employer are not required to do anything new to stay enrolled — provided the employer's coverage meets basic requirements. Also, some employers may choose to provide new coverage options, such as through the Covered California Small Business Health Options Program (SHOP). Employers must provide notice to their employees about any changes.
Covered California is the state agency that is running a new, easy-to-use marketplace where individuals and small businesses can shop for health coverage and choose the coverage that best fits their needs and budget. Individuals may be eligible for low-cost or no-cost Medi-Cal or to receive financial assistance to make health care more affordable. Tax credits are available for qualifying small businesses, also. For more information about health care options that are available, visit CoveredCA.com or call (800)300-1506. (Representatives who speak languages other than English are available.)
Only individuals certified by Covered California are authorized to help consumers enroll (complete an application) in health insurance plans offered through Covered California. There are five kinds of individuals authorized by Covered California to provide enrollment assistance:
- Covered California Service Center representatives.
- Covered California Certified Enrollment Counselors.
- Covered California Certified Insurance Agents.
- Covered California Certified Plan-Based Enrollers.
- Certified county eligibility workers.
All of these trained and certified individuals are authorized to provide enrollment assistance for both Medi-Cal and for the full range of Covered California health insurance plan options.
Covered California is also working with community organizations and educators to provide information about the new health insurance marketplace. Covered California Certified Educators will be at many public events and may approach you in person to ask if you are interested in health insurance. Certified Educators may take down your contact information so that Covered California can follow up to help you enroll; however, Certified Educators are not authorized to provide enrollment assistance (i.e., they cannot help you complete the application for health insurance).
Only Certified Enrollment Counselors, Certified Insurance Agents, Certified Plan-Based Enrollers and certified county eligibility workers will be conducting in-person enrollment on behalf of Covered California. Service Center representatives can assist you by phone. If somebody is asking for your confidential information, you can always independently verify that the individual is certified by Covered California by calling our Service Center at (800)300-1506 or checking our website's consumer protection section.
To verify whether someone seeking to assist you with enrollment is certified, you should ask them for their:
- Full name.
- California insurance license number (for Certified Insurance Agents, who are licensed by the California Department of Insurance).
- Covered California certification number (for Certified Enrollment Counselors and for Certified Plan-Based Enrollers).
- The name of the Certified Enrollment Entity, the health insurance company or the county they represent.
When you are ready to enroll, you will need to provide the following information:
- The full name, date of birth and Social Security number of the individuals in your household that you seek to enroll in coverage.
- For the primary applicant, proof that you are who you say you are (“identity proof”), such as a driver's license or other ID.
- Household income information. Most people will find it helpful to have their most recent federal tax return to gather this information, including any income from dependents. Social Security numbers of non-applicants may be requested, to verify income information, but alternative proof of income can be provided.
- Your home address. If you do not have a home address, you are only required to provide a mailing address.
- Information about which members of your household are going to be insured. To determine if you are eligible for special programs for mothers and infants, we will ask if anyone in your household is pregnant or if they have a disability.
- Proof of satisfactory immigration status (citizenship or lawful presence).
For 2014, open enrollment for the health insurance plans offered through Covered California runs from Oct. 1, 2013, to March 31, 2014. Coverage can begin as soon as Jan. 1, 2014. Enrollment is not finalized until your premium payment has been received by your health insurance company. If you are found eligible for Medi-Cal, you can enroll year-round. The next open enrollment for health insurance plans offered through Covered California will be during the fall of 2014, for coverage beginning in 2015. However, if you experience certain life-changing events — such as the birth of a child, a marriage or unemployment that results in the loss of employer-sponsored coverage — you may qualify for a special enrollment period outside of open enrollment.
If you are eligible for Medi-Cal, you may have free coverage. In general, when you enroll in a health insurance product through Covered California, you will be billed by your health insurance company directly. If you are eligible to receive premium assistance from the federal government to reduce your costs, you can choose to receive that support as a monthly advance that is paid directly to the health insurance company so you pay less each month, or you can choose to receive less assistance each month and get the rest of the credit as a refund when you file your taxes at the end of 2014. Your coverage does not begin until your first premium is received by your health insurance company. Beginning in January 2014, you may have the option to transmit your first month's premium through CoveredCA.com in order to make your coverage take effect sooner, but this will never be required.
Certified Enrollment Counselors are prohibited from handling your payment information. Certified Educators do not offer enrollment assistance and thus are similarly prohibited from handling payment information.
In keeping with current laws and practices for licensed insurance agents and health insurance companies, both Certified Insurance Agents who are licensed by the California Department of Insurance and Certified Plan-Based Enrollers, who are employees of the health insurance companies, are authorized to collect premiums.
Alert Covered California by calling (800) 300-1506 or by emailing us at firstname.lastname@example.org. Our Office of Consumer Protection will track and investigate complaints and refer to law enforcement as appropriate. Identity theft is against the law and is punishable by imprisonment and fines.
1. Alert Covered California to tell us how you were victimized, by calling (800) 300-1506 or emailing us at email@example.com.
- Covered California’s Office of Consumer Protection tracks complaints about any fraud connected with enrollment in Covered California and will investigate, follow up and work with law enforcement as appropriate on a case-by-case basis.
2. Protect yourself! Learn immediate steps you can take if you have been scammed and may be a victim of identity theft, including how to file a police report and alert your creditors:
- California Office of the Attorney General checklist for identity theft victims: www.oag.ca.gov/idtheft/facts/victim-checklist.
- Federal Trade Commission information on identity theft: www.ftc.gov/idtheft. You can also call (877) ID-THEFT.
3. File a complaint with the Federal Trade Commission:
- The Federal Trade Commission is specially tracking complaints related to the implementation of the health care law and will enter your complaint into the Consumer Sentinel Network, a secure database that's available to law enforcement agencies across the country. Your complaint helps them identify and take action against fraud. Visit https://www.ftccomplaintassistant.gov or call (877) FTC-HELP.
4. If the fraud you experienced or are concerned about involves an individual who says they are an agent or who is actively seeking to sell insurance, you can also call the California Department of Insurance's Consumer Hotline at (800) 927-HELP.
5. If the fraud you experienced or are concerned about related to Medi-Cal, you can call the Department of Health Care Services Hotline at (800) 822-6222, email firstname.lastname@example.org, or fill out an online complaint form.