Letter of Understanding for Late Applications
Some Insurance Companies #kaiserform for example have a form that must be signed when
applications are sent in late to avoid any misunderstanding.
In order for your group, ___________to be considered for late enrollment for a/an _________effective date, both customer and broker will need to sign this letter of understanding.
Complete group eligibility and enrollment documentation must be submitted. This letter and/or group submission do not guarantee approval, but rather consideration for a/an _____effective date.
Please note the following potential liabilities of a late enrollment:
Customer is responsible for the full month’s premium – no proration or refunds
Effective date of coverage will not be changed to a future date
Potential impacts to members:
Members will not have member ID cards, nor be active in systems, including medical facilities, until enrollment is complete and processed, which could take 7- 10 business days beyond submission
Members may be billed or asked to pay at point of service. Kaiser Form *
Realistic Drop Dead Deadline Date?
What if you apply on March 30th for an April 1st effective date and you don’t get ID cards till April 24th,
do you have to pay April premium?
What about trying to collect on claims paid out of pocket?
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#SNAFU - Situation Normal - All Fouled Up
I learned the word SNAFU Situation Normal, All Fouled Up in the dorm, when I attended San Diego State in the early 70's and earned a degree in Insurance. In all that time, I've never been able to use the word in a sentence, until last 10.1.2013, when Covered CA.com, Health Care.Gov nor the Insurance Company Websites or my own Quote Engine that I pay around $250/month for were supposed to launch, but did not do it properly.
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Mistake – Dealing through parents for #Competent Adults
We recently had a parent call and enroll his daughter in Covered CA with subsidies. The daughter now has found a “rule” that states that she should have always been in Medi-Cal as her child’s Social Security Survivor Benefits do not count, for MAGI Income. We don’t need the grief, look at the Long Story she wrote us…
So, unless you have authority, we can’t help you, unless the child is on the Zoom call too.
Who has authority to #sign an application for Insurance?
Can a Parent negotiate and purchase coverage for a competent adult child?
Age of Majority 18 The age when a child legally becomes an adult. The age of eighteen in California becomes the age of individual freedom for the individual. You become a full-fledged citizen with the right to make your own choices – and, consequently, pay the consequences for your own mistakes.
A legal guardian is a person who has the legal authority (and the corresponding duty) to care for the personal and property interests of another person, called a ward. Guardians are typically used in three situations: guardianship for an incapacitated senior (due to old age or infirmity), guardianship for a minor, and guardianship for developmentally disabled adults.
Most countries and states have laws that provide that the parents of a minor child are the legal guardians of that child, and that the parents can designate who shall become the child’s legal guardian in the event of death, subject to the approval of the court. Some jurisdictions allow a parent of a child to exercise the authority of a legal guardian without a formal court appointment. In such circumstances the parent acting in that capacity is called the natural guardian of that parent’s child. Wikipedia
- Our webpage on Conservatorships
A power of attorney (POA) or letter of attorney
is a written authorization to represent or act on another’s behalf in private affairs, business, or some other legal matter. The person authorizing the other to act is the principal, grantor, or donor (of the power). The one authorized to act is the agent or, in some common law jurisdictions, the attorney-in-fact. Wikipedia
A health care agent is a person you choose in advance to make health care decisions for you in the event that you become unable to do so. A health care agent can help make medical decisions on your behalf at the end of life or any other time you are not able to communicate, such as if you are severely injured in an accident. A health care agent also may be called a health care proxy or surrogate or an attorney-in-fact. Web MD Agent of Health Care Fillable Form
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I’ve filed a recent grievance complaint with LA Care because their methods are opaque.
For some reason, none of my out of pocket expenses are being applied to my pharmacy deductible, and I want to know precisely why. Their service center was clueless under questioning.
My specialist co-pays are too high also.
I don’t believe in calling and asking technical questions.
Try looking at your Evidence of Coverage
I asked you a simple “quick” yes or no question.
Why can’t you just give me a yes or no!!!
I’d love to, but as you know President Trump said Insurance was very complicated and no one knew (except me).
My mandatory annual training for Medicare Advantage also knew and an agent can get in BIG TROUBLE for giving simple answers which may mislead or misrepresent the coverage or how it works.
We are not even allowed to answer the question:
Is this the best plan?
40.4 – Prohibited Terminology/Statements
You can’t Use absolute superlatives (e.g., “the best,” “highest ranked,” “rated number 1”) and/or qualified superlatives (e.g., “one of the best,” “among the highest rank”) unless they are substantiated with supporting data
The superlatives used and the data provided must be in context and may not mislead consumers CMS.gov 2015 * 42 CFR 422.2262, 422.2264, 423.2262, 423.2264, 422.2268(e), 423.2268(e)
How can I visit with my my cardiologist if I don’t have insurance information???
You do have Insurance Information! Here is where your application is shown as pending in my broker portal. We also sent this to you on the 23rd.
There is no requirement to have Insurance to visit a doctor or hospital. If nothing else, put the bill on your credit card and then file a claim. Here’s the form
Here’s a form that one Insurance Company requires when applications are submitted late.
I recall when I studied at San Diego State and received a BS in Insurance (see our biography page) one of my professors Mr. Charles Muse, CLU explained that there is no requirement to have coverage to get treated. He just paid and then let the provider send a bill, he would file a claim form.
We also learned that Insurance is for the BIG things that can cause economic disaster that one can’t plan for. Sure, Insurance has changed and now includes preventative care
When you ask the Insurance Company to pay every little thing, it only jacks up your costs. Insurance Companies keep 20% of every premium dollar they take for expenses and profits. It was that way before ACA/Health Care Reform and the ACA made it law. See our page on MLR Medical Loss Ratio.
Under the ACA everything is guaranteed issue. Pre ACA you would have had to fill out complete details of your medical history and then you might have been denied or had your heart condition excluded as a pre existing condition.
That is why, one can normally only buy coverage at Open Enrollment or Special Enrollment, not while you are being admitted to the hospital.
So, in your case, where you lost employer coverage, one needs to PROVE that!
While you applied for coverage on the 10th, you didn’t comply with the requirement to send proof of loss of coverage till the 23rd. Who moves that fast? It took you two weeks to comply, you expect the Insurance Company to finish up everything in a week?
What is your doctor’s email address? I’ll email them and explain the situation.
More on my professor Mr. Chuck Muse, CLU