If you apply late, last minute for coverage, when does it start?
Conditional Eligibility?

Covered CA 90 #Conditional Eligibility 

A 90 day conditional eligibility notice  means that you get coverage for 90 days even though Covered CA hasn’t verified that you qualify.  As long as you send the proofs that are being asked for, everything is fine!  There is NOTHING to worry about!  Just comply.  If you have trouble with compliance, email us.

Clients need to submit valid documentation for one or more of the following reasons:

You  can uploadfax, send to their Certified Agent or mail their documentation. More than one document may be required.

View our Conditional Eligibility Quick Guide * or Job Aid for more information on the notice and to view a list of acceptable Verification Documentation.

Look for this sentence in the letter that you get from Covered CA.

We need your proof within 90 days. If we get a response and you prove your citizenship by the due date above, you will keep your insurance through Covered California.

Here’s the biggest lesson I learned in one year of law school.  Read everything 3 times and when you think you understand it, read it again.

conditional eligibilty

Covered CA Certified Agent

#Covered CA Certified Agent  

No extra charge for complementary assistance 

I'm in Sonia

 

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?

SNAFU - Situation Normal - All Fouled Up
snafu

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.

Get a term life quote here,
to protect your loved one

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?

legal authority to sign application

Parent

Legal Ages CA

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.

Guardian

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

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 principalgrantor, or donor (of the power). The one authorized to act is the agent[1] or, in some common law jurisdictions, the attorney-in-factWikipedia

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

7 comments on “Last Minute Application? When does coverage start? Competent Adults

  1. 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.

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