Grace Periods under Health Care Reform
are a REAL problem!!!

Especially if OPEN Enrollment is Closed! 

Coronavirus? Special Enrollment?

The Grace period under Health Care Reform is:

31 day's if you are direct with an Insurance Company & don't get subsidies Specimen Policy Page #39 * Health & Safety Code 1365 a 1 * dmhc.ca.gov guidance

Grace period for recipients of advance payments of the premium tax credit.

An Insurance Company - (QHP Qualified Health Plan issuer) must provide a grace period of three consecutive months if an enrollee receiving subsidies - (APTC advance payments of the premium tax credit) has previously paid at least one full month's premium during the benefit year. Health Care.Gov *   45 CFR 156.270  (d

Full payment is required to keep coverage in force

If any of your clients find themselves in a grace period situation, make sure they understand that making partial payments on the debt will not serve to extend the coverage period, stretch out the grace period or delay cancellation.  After they’re notified about premiums overdue, they must pay the full amount owed before their grace period ends to avoid losing their coverage. Insurance Company memo

Way more detail, law & Regulations 

 

Some payment plans - options are more liberal due to the Coronavirus pandemic.  Click on the prior link for more information for all companies in CA.

CA Department of Insurance is requesting

all Insurance Companies provide a 60 day grace period

To July 14th, 2020

 

Here’s the notice the DOI sent.

July 14th Notice 

Visit our webpage on Insurance Coverage for COVID 19

 

 

Payment options

• Pay Online – Clients can go to anthem.com/ca, log into their account and click on the Pay My Bill Online link

• Pay By Mail – Clients can mail their invoice with payment. They must mail in time for us to get it on or before the last day of the grace period.

• Pay By Phone – Clients can call the number on the back of their member ID card to use our free Auto Pay Phone Service. Or, they can call Member Services at (855) 634-3381 to pay by credit card or check.

Blue Cross – Ways to pay premium

Covered CA – Ways to pay

Consequences of cancellation

Once a member is terminated for non-payment, they cannot be reinstated.  

In the past, as an agent, we would get late notices, now we don’t or rarely do.  So, read up, email us and let’s see what we can do to keep coverage in force for when you need it and avoid tax penalties, bankruptcy or not getting the medical treatment you need – 10 essential benefits.

Clients need to know that cancellation for not paying premiums can have serious consequences. Here’s what happens if they lose their coverage:

• They will still owe unpaid premiums for the first month of their grace period

• They will still owe providers for any health care services they got during the second and third months of the grace period

• They will have to repay any premium tax credits   form 8961095 A   the government paid on their behalf during the second and third months of the grace period

They won’t be able to get new coverage for themselves or their dependents until the next open enrollment period, unless a life event triggers a special enrollment period

Cancellation for Non-Pay –  won’t be a qualifying event either!!!

If you own a business – a group plan.

Wild Thoughts?

Are you having a bad month?  Low income this or the next few months?   Try Medi-Cal.  They use monthly income and annual income, whichever is lower!   Medi-Cal will give you coverage that meets all 10 essential benefits, plus CA mandated benefits!   If your income goes back up, that gives you a special enrollment period back into Covered CA where we can be your agent, no extra charge, Covered CA pays us to help you or direct with an Insurance Company, get a quote.

 

Try qualifying for Minimum – Catastrophic coverage?

 

Health Insurance Premiums - ExplainedHealth Insurance Premiums - Explained

Check out Special Enrollment -
Change in Income,  Enhanced Silver (Cost Sharing Reductions)? * ARPA * COVID 19?

See if you are lucky and can find a special enrollment reason to re-enroll for coverage
See if you are lucky and can find a special enrollment reason to re-enroll for coverage

What is the proper way to #cancel Health Insurance?

So that I don’t have to pay extra premiums

I’m not restricted when, if I want to reapply.

Don’t have problems with Advance Premium Subsidies

Just let Covered CA or your Insurance Company know at least 15 days ahead of time.  See the menu above for the administrative page – contact information for each Insurance Company.  However, take a look at this excerpt of email from Covered CA dated 5.24.2018:

 

Agents and client can cancel the plan directly in the web site but they need a 15 day window to terminate at the end of the month. If it is less than 15 days of the termination date, they need to call Covered California. We can terminate it with less than 14 days.

We provide this service for our clients, who do not pay extra as we are paid by the Insurance Companies when we are appointed as your broker.   However, we must have  proof of new coverage.   We will not cancel a policy for a client, without proof of new coverage.  We don’t want to become the Insurance Company.

The main point is not to let coverage lapse for non-payment of premium as the Insurance Company might send a 10 day demand letter and send you to collections.  Saying you didn’t use the Insurance won’t work.  That isn’t what Insurance is. Risk Pooling.  Proving that you have other coverage will probably work.

Resources & Links

45 CFR § 156.270 – Termination of coverage or enrollment for qualified individuals.

§ 155.430  *   Termination of Exchange enrollment or coverage.

One reason for the

#Narrow Network – 3 month Grace Period

is that DOCTORS, Hospitals & other providers do NOT get reimbursed if a policy gets cancelled, because the insured did not pay their portion of the subsidized premium in the 2 or 3 month of the grace period.  45 CFR 155.430 (b) (2) (ii) (A) & (B) and 156.270 (d) – Federal Regulation 41866

See our page on Balance Billing for information at AB 72 to help resolve the issue of going to a hospital or doctors office that is on the list, but still getting out of network bills.

(d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month’s premium during the benefit year. During the grace period, the QHP issuer must:

(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

(2) Notify HHS of such non-payment; and,

(3) Notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period.

(e) Advance payments of the premium tax credit. For the 3-month grace period described in paragraph (d) of this section, a QHP issuer must:

(1) Continue to collect advance payments of the premium tax credit on behalf of the enrollee from the Department of the Treasury.

(2) Return advance payments of the premium tax credit paid on the behalf of such enrollee for the second and third months of the grace period if the enrollee exhausts the grace period as described in paragraph (g) of this section. 156.270

Benefits of #Automatic Premium Payments

Easy Pay - Automatic Payments

What if you’re in a coma in the hospital when the premium is due?

Here’s a Long Story –

Bill Duncan* called in and asked if we could get medical insurance for his Mother who has an adrenal problem and possibly has Addison’s Disease and is on Paxil for Major Depression.

Her prior coverage had lapsed for non-payment of premium as she states that she has memory loss due to her medical conditions.   The Insurance Company** so far has told them that they won’t reinstate and said that they would send a grievance form for them to fill out.   I found a standard grievance form and emailed it to my friend.

I don’t know how this will come out, but I looked all over the California Case Law section on  FindLaw.com and so far have found nothing in the sister’s  favor.  The closest cases were on Life and Disability Policies that had a special provision at additional cost that will pay your premiums, if you are disabled for say 6 months or more.  Under COBRA and other Insurance Laws, Anti-Discrimination, etc. they all allow cancellation for non-payment of premium.

Here’s a letter from an Attorney on a similar issue.

The only medical plan I can find for her at this point is MR. MIP, which is really great as it covers virtually anyone who for medical reasons can’t get Individual coverage, the down side was that they have a  waiting list to get in.

So, the moral of the story is, make sure that you have a method to pay your medical premiums so that the Insurance Company can’t cancel you, when you need it the most!

Unfortunately, if you can’t remember to pay your premiums, you will probably have trouble working too.  Check out Disability Coverage ,  if you have a Retirement Plan or Cash Values in Life Insurance you might be able to access that money.  If all else fails the Government has various plans available.  Healthy Families to cover your children, Medi-Cal if you’ve become poor,  Social Security Disability – SSI which will qualify you for Medicare – after 2 years of disability and the Free Clinic.

*Name changed for privacy

**Insurance Company named not mentioned as we may be filing a grievance and as near as I can tell, all companies and HMO’s would cancel for non-pay, regardless of the reason.

Blue Cross form  Ways to pay your premium or Email us for the form to have your premiums automatically withdrawn from your checking account or credit card

Blue Shield
No more reinstatements on late payments 1/1/2010

Find Member Portal for Individual Health Companies CA 

If you #lose your Advanced Premium Tax Credits (APTC) be careful,
One Can lose ALL Coverage for just missing ONE month Premium!

 

Excerpt of email blast from one or our carriers:

We are aware that some of our members lost their subsidy and now owe a full month of premium payment(s).  Some were able to supply proof needed by the exchange and had their subsidy reinstated, however there is a month or more gap where the government subsidy lapsed, therefore the member is responsible for the full premium during that time.   We sympathize and understand that most of our members cannot afford to pay a full month and are therefore skipping that month and trying to pay the following month.

We are receiving a lot of questions asking:

“If the client does not pay the month(s) without subsidy and they pay the following month with subsidy will they be able to use the insurance?”

Unfortunately, the answer is No, they will not.  Members must pay their responsible portion of the premium or the policy will lapse. For example:

Month of May Member’s responsibility after applying the subsidy is $22.50 (member sends in $22.50)

Month of June Member’s responsibility is the full Premium after subsidy lost is $550.00 (member did not pay)

Month of July Member’s responsibility after applying the reinstated Subsidy $22.50 (Member sends in $22.50)

In the example noted above, since the member did not pay for the month of June, the $22.50 will be applied to the June premium of $550.00 leaving a balance of $537.50 owed for month of June, and $22.50 still owed for July which will bring it back up to a balance due of $550.00.  If the whole balance is not paid, the member will be suspended and will have no coverage until account is brought to current status.

After 90 days the client will be terminated for non-payment, and, unless they have an SEP – Special Enrollment Period, cannot enroll again until open enrollment starting in November and no coverage till January 2016.  Molina will not send the member to collections for the owed amount however; they will still owe that until paid in full.

The member always has the right to file an appeal to the Exchange.  They would need to submit a letter or an Appeal Request form to:

Health Insurance Marketplace Attn. Appeals

Department of Health & Human Resources

465 Industrial Blvd, London, KY 40750-0061

The following information MUST be in the uppers corner on EVERY page, If not on a page it will NOT be considered as received:  First and last name, SSN# and State.

Successful eligibility appeal results will be communicated to the Issuer via a HICS case.

Thank you for your inquiry and hope this information helps in the future. As always if you have any questions please feel free to give us a call.

Guaranteed Issue – No Pre X Clause
Quote & Subsidy Calculation 
Find out your premium with Covered CA
or Direct without Subsidies

Instant complementary quotes & subsidy calculation

Missed Open Enrollment?
See our Special Enrollment page

No charge for our complementary services 

Detailed Video Instructions on using our Quote Engine

detailed instructions to use quote engine

How to use our FREE Quote Engine, Subsidy Calculator  and get the MOST from the experience.

When you get a FREE quote, you can also see the benefits, view actual brochures, MD and Hospital Lists all ONE easy process with no obligation & it can be anonymous.   Enter your zip code, date of birth, family – household taxation relationships (MAGI – Definition),    Estimated MAGI – Modified Adjusted Gross Income for the upcoming – current year.  Last years tax return only gives an idea so that Covered CA can approve your advance tax credit to help pay premiums.

If you qualify for tax credits – subsidies and want them in advance (Pros-Cons) of filing your taxes click on “Health On Exchange” – Covered CAillustrated below.

This website and are individual consultation are provided to you FREE of Charge!  We are paid by Covered CA and/or the Insurance Companies to help you.  When you fill out the Covered CA ONLINE Application, just appoint us as your agent under Find Help in the Upper Right Hand Corner so that we get paid for helping you.  Click here for screen shots for more detail of how to do it.  If you prefer, you can pay us a consultation fee in lieu of appointing us as your agent, for educational services only.

You can then see all the quotes on the exchange, showing the Cost Share Reduction – Enhanced Silver  if available, subsidy – tax credit amount and your net premium.    If you click “Off Exchange” you will see more plans and companies which  may have larger provider lists.   Scroll down for more screen shots.

Then click on “View Plan Details” – “View Doctor’s & Providers” – to compare and get more information.  Please note that the quote engine does not show enhanced silver, but shows silver at 70%.  Check our chart for the better silver coverage.

Learn more about the right to change plans when Silver Level Enhanced Changes

To apply, click on apply now or use the links in the right hand column, ON THIS PAGE, but it will have you redo the quote for that specific company.   The price is the SAME, no matter if you use us, go direct to Covered CA or the Insurance Company, as mandated by law!  If applying through Covered CA, be sure to sign the form to appoint us as your agent.  It’s not all the easy to figure out how to do it on their website.

If you have any questions email [email protected] or call us 310.519.1335

Get FREE #Instant Individual & Family  California  Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Claus

Get FREE Instant Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Clause

Full Instructions to use Individual Quote Engine
Takes all the complexity out of CFR §1.36B-3 *

how to get quote - full instructions video by steve

Grace Periods 

Cancellation for non-payment of premium:

When premiums are not paid, coverage will cancelled due to non-payment following our standard grace period rules (see below). Members will receive a notice when premium is past due. The notice includes the date when the grace period ends and that coverage will terminate unless the member sends the full past due amount before the grace period ends. Reinstatement is not allowed if the policy is cancelled for nonpayment.

The grace period is an additional period of time during which coverage remains in effect and refers to either:

 The three month grace period required for individuals receiving Advance Payments of the Premium Tax Credit
(APTC), or
 For individuals not receiving the APTC it refers to any other applicable grace period (All States except Maine:
31 days; Maine: 30 days).

If the full amount of the premium is not paid by the premium due date, the grace period begins. If the required premium is not paid by the end of the grace period, coverage is terminated. The member is not be eligible to apply for other coverage until the next open enrollment period unless they experience a qualifying event. See below for specific information about the two types of grace periods.  

 

Grace period for members receiving Advanced Premium Tax Credits (APTC)

Members who receive APTC are provided with a three month grace period.

During the first month of the three month grace period, coverage remains in effect.

During the second and third month of the grace period coverage will be suspended and the member(s) will be ineligible for benefits under their health benefit plan unless they pay all premiums due before the end of the grace period.   Any outstanding authorizations, approvals for services or certifications for health care services to be provided during or after the  second and third month of the grace period are also suspended. We will not provide any benefits or coverage for services, supplies,  or prescription drugs obtained while the suspension is in effect even if previously approved, authorized or certified.

The application of the grace period to claims is based on the date of service and not on the date the claim was submitted.

If full premium is not received during the grace period, members:

 Will have no coverage for claims incurred after the first month of the three month grace period. They are liable for the full cost of any services they receive after the first month of the three month grace period.
 May be required by their health care providers to pay for any health care services they need.
 Will be liable to us for the premium payment due for the period through the last day of the first month of the three month grace period.
 Will be liable to us for any claims payments made for services incurred after the last day of the first month of the three month grace period.
 May be required to repay any premium tax credits the government paid on their behalf during the second and third months of the grace period.

If your client makes timely payment of all premiums due before the end of the grace period, coverage will be reinstated, and claims for covered services received during the grace period will be processed.

Grace period for members not receiving APTC

These members have a grace period of 31 days (in all states except Maine which is 30 days). This means if any premium payment is not paid on or before the date it is due, it may be paid during the 31 (30 in Maine) day grace period. During the grace period, coverage will stay in force. If the full premium payment is not made during the grace period, coverage will be terminated on the last day of the grace period. They will be liable to us for the premium payment due including those for the grace period, as well as for any claims payments made for services incurred after the grace period.  Copied from Blue Cross CONFIDENTIAL agent manual Form 03673MUBENMUB 10/25/16  *

See also this jpg from Blue Cross Confidential Manual

Grace Period & Cancellation Procedure
Reference Materials

ocregister.com/2014/ask-emily-covered-california-is-a-hard-plan-to-cancel/

Insure Me Kevin.com terminating coverage for Covered CA can be tricky

health for california.com/covered-california/cancel-existing-plan

 

Examples of how a three-month grace period works

Copies of emails to clarify the rules:

Let’s say your client entered the grace period and owes premiums for two months. Here’s an example of what can happen:

• During the first month in grace period, your client’s health benefits stay in effect.   We will honor claims incurred during this period. Your client must still pay any unpaid premiums, copayments, coinsurance and deductible amounts, as set forth by the health plan. • During the second and third months of the grace period, your client’s coverage will be suspended.

No one on the plan will be eligible for benefits, unless the full amount due is paid before the end of the grace period. During this time, we will not pay for any health care services, supplies or prescriptions, even if they were approved before. Now, let’s say your client pays for one of the two overdue months right away. Doing so will not extend the grace period or delay suspension, as the grace period moves into the second month. Your client will be on the hook for any claims during this time while coverage is suspended, unless the account gets paid in full before the grace period ends. Ultimately, if your client doesn’t pay the remaining amount due by the end of the grace period, we will cancel coverage. We also will refund the partial premium payment made in the second month because it doesn’t cover the full premium owed. We will only honor claims incurred in the first month of the grace period.

Premium payment grace period clarification

Regulations require a 90-day grace period for on-exchange members receiving subsidies for their health plan. For off-exchange members not receiving subsidies, the grace period is 30 days. For a member who is on a 90-day grace period and does not pay 100% of their total premium due, the grace period does not start over.

Example: A member owes $600.00 for their premium for March and April. In April, they pay one month’s premium for the month of March. In this scenario, the member is still in their 90-day grace period with 30 days left until they are cancelled.  Blue Shield Agent Email 6.7.2016

Here are excerpts various bulletins we’ve received about Grace Periods under Health Care Reform

New Payments (Covered CA) can be made here. Policies cancelled for NO reason or explanation

Learn More ==>  CA Health Line 3.22.2016 Learn More ⇒ Molina bulletin

In either case, the grace period starts on the date we mail members the first warning notice that their premium is overdue. The letter tells them when their grace period ends. It warns that they will lose their coverage unless they send us the full past due amount before the grace period ends. It says we won’t be able to reinstate them afterward, if their policy gets canceled for not paying premiums. We also send them one or more reminder letters repeating this information, depending on how long their grace period is.

Grace Period and Review of Cancellation in Sample EOC Evidence of Coverage – Policy

Health Net Cancellation Procedures

 

References & Links

45 CFR § 156.270 – Termination of coverage or enrollment for qualified individuals.

§ 155.430  *   Termination of Exchange enrollment or coverage.

71 comments on “Grace Periods? NEVER get cancelled Non-Pay!!!

  1. 4 comments on “Automatic Premium Payments – Benefits and Advantages”

    1. Proof of an Automatic Payment?

      Question

      1. My credit card was on file with Anthem Blue Cross Platinum PPO for monthly payments of my premium. I do this with all of my insurance plans: house, health, and car. I have never had a problem.

      2. After my daughter got sick and I was told her prescription wasn’t covered, that pharmacy wasn’t available, I did some investigation by phone and was told that my insurance was canceled and it cannot be reinstated. I am floored and sick to my stomach. I did nothing wrong.

      3. I cannot even find the page for payment where my Visa CC was stored on the website.

      Reply

      1. I guess the big issue here is proof, evidence and establishing that Blue Cross had you set up on Auto Pay. Please email us everything you have to show that you were. Please also send us your user name & password to your BC online account and Covered CA if you have thatWhat about the late notices and cancellations they are mandated to send you?

      What payment were withdrawn from your credit card?

      3. Send us the user name & password of your BC online account. Also, we can contact BC on your behalf if you authorize us as your agent and we will look for what we can in your favor.

      If all else fails, there are temporary plans, but most do not meet minimum essential requirements, thus you pay the fine and do not cover pre-existing conditionsMr. Mip will though.

      Reply
    2. Premium Due Date vs Automatic Bank Withdrawal

       

      I have a question regarding on paying auto pay. It says my payments will be taken out every 23 of the month. When is my payments due? If I remember correctly you said it is due every 1st of the month?

      Answer

      The payment is due on the 1st of the month.  Your coverage then goes into the grace period if not paid on the first.

      I will check what options Molina has for the withdrawal date.  Here’s a link to the various ways to pay your premium with Molina.   Here’s the Molina Member Portal.   Create an account and see if you can change the auto withdrawal date.   It might be that the 23rd came up as you are doing the first payment on the 17th…

      Reply from Molina

      The Autopay is not set-up to allow member to select a payment due that they wish, the 23rd is in place to ensure payment is received and applied for coverage for the following month-it is clearly stated in the Terms and Conditions when enrolling. (see below)
      Here’s definitions  from a specimen policy on when the premium is due.

      All Monthly Premium Payments and administrative fees are payable in advance and due on the Monthly Premium Due Date. The Monthly Premium Due Date is the first day of the Plan period for which we receive Premium Payment. For example, if the Plan Period is March 1 to March 31, the Monthly Premium Due Date is March 1. The Plan Period is not affected by and does not affect the use of other periods of time to measure or determine Your rights and benefits, for example, the use of the calendar Year as applied to Deductible, or the use of the calendar Year to determine maximum Copayments/Coinsurance  – Page 32

      For Your convenience, You may authorize us to automatically deduct Your Premium Payment from Your financial institution account every month. To learn more about this option, contact customer service.  Page 33

      The grace period for payment of future premiums is thirty (30) days from the Monthly Premium Due Date. If You fail to pay premiums as they become due, xxx may terminate this Agreement as described below as of the last day of the grace period.  Page 39

       

       

       

      Auto Withdrawal Premium Payment Confirmation
      Auto Withdrawal Premium Payment Confirmation

       

      Auto Pay Defaults to the 23d
      Auto Pay Defaults to the 23d
      Reply
    3. I knew that I hadn’t made my health payments through Blue Shield of Ca via Covered ca for a few months, but I failed to realize i had gone too long.

      ***Right.  It’s 90 days if one is getting subsidies.

      Previously I made payments easily with Health Net ,since I changed over to Blue Shield I  have had issue logging in and being able to call in during business hours.

      ***Do you have a member portal?

      Reply
    4. Jeremy C says:
      April 14, 2017 at 2:04 PM
      Hello,

      I got a cancellation notice from anthem today because they have not received the current payment.

      I thought they were debiting my checking account, as that as how it has worked for the past five years, but apparently not this year.

      Anyway, wondering what might be done to get some kind of insurance policy in place or reinstate this one.

      We don’t have anything particular going on health wise, but you have to have it.

      Two parents, 62 and 51, daughter 21, daughter 20, son 18, daughter 15.

      Any suggestions. Hard to believe that they will cancel with no warning, just like that…

      Jeremy C 434 xxx

      Reply
      Steve Shorr says:
      April 14, 2017 at 2:22 PM

      Since you were on Auto Pay – I think we would have a good chance to appeal the cancellation. Do you have all the proofs? See our pages on appeals & grievances. Do you have anything that might qualify as a special enrollment period, as cancellation for non-payment of premium doesn’t count. Be careful as next year under new CFR 9929 F Insurance Companies can make you pay past due premiums before writing you at Open Enrollment.

      Check our temporary insurance pages for quotes. You can also get California Quotes here and Nationwide here. The downside to temporary plans is that they don’t meet minium essential coverage or benefits for the mandate nor do they cover pre-existing conditions.

      Reply
  2. What are my options as far as not #paying for the months I didn’t have coverage?

    FAQ’s

     

    Reply

    ***Pretty much none.  If you don’t pay, you won’t be able to get coverage till next Open Enrollment as you haven’t mentioned anything that would qualify you for special enrollment.  Check out our page on temporary plans to tide you over till then.

    Question

    My payments [subsidy – APTC Advance Premium Tax Credit] changed this year because my income is less than last year.

    ***Next time try the complementary agent support and have someone experienced like us help you with these problems and hopefully let you know in January.   We only get paid if you appoint us.   Did Covered CA or Health Net give you an explanation as detailed as this page, without waiting on hold?

    Question

    I’ve been told by Covered CA I will probably be reinstated but I will have to back pay for the months I didn’t have coverage (Feb., March, April, May, and maybe June).

    ***As soon as you prove that your payment was $208, you did have coverage.   Can Health Net prove they sent you a cancellation Notice in January?

    45 CFR 156.270  (d) Grace period for recipients of advance payments of the premium tax credit. A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously paid at least one full month’s premium during the benefit year.

     

    Question

     

    If I don’t have coverage are there any other problems besides the  fee [Mandate Penalty 2.5% of Income] at the end of the year for not having health insurance for those months..

    ***Are you OK with paying bills out of future earnings or losing your home and assets and bankruptcy if you have a large unexpected medical problem?

    Scroll down for more FAQ’s or to ask a question.

     

     

    Resources & Links

     

    If you want to file and appeal – as you think you were  mislead and get a new special enrollment period – click here for our appeals page.

    See our page on – was the cancellation legal?

     

    12 comments on “Paying Back Premiums to get reinstated?”

    1. Anonymous says:

      i had coverage starting in January.

      i had a change in income, applied for new coverage and received special enrollment in May.

      January, Feb paid with zero balance,

      March premium paid on April 13

      and new policy starting may 1, first month premium paid on April 20. April remained unpaid.

      i contacted Blue cross to make payment for April and June on June 8th and was informed i was cancelled for non payment as of APril 1st.

      Reply
      • Where you getting subsidies on the policy you got in May? See 45 CFR 156.270 (d) above. Did you cite any law in your appeal? Did you provide proof of payment?

        Reply
    2. Anonymous says:

      Is there and advocate for Pennsylvania that can assist me with my coverage being cancelled for non payment?

      i have filed appeals with BLue Cross and been denied for reinstatement.

      i have filed appeal with Pennsylvania Department of Insurance and been denied for reinstatement.

      i have filed a complaint with Better Business Bureau and have had my case closed unanswered.

      i am in the process of filing appeal with the Markeptlace.

      Reply
      • Not that I know of. Try googling more. Try legal aid. The Department of Insurance should have been able to help you.

        Did you review our pages on how to file an appeal? What were the reasons you were given for denial?

        Reply
    3. Anthony says:

      I found a form online to request a hearing. The form is called “Request for a State Fair Hearing to Appeal a
      Covered California Eligibility Determination”.
      Here’s a link to the form:
      https://www.coveredca.com/PDFs/HearingRequestFormCC.pdf

      I called the number on the form. (1-855-795-0634) I was able to submit an appeal over the phone instead of having to send in the hearing request form.

      I will let you know how it all turns out.

      Reply
      • Steve Shorr says:

        In my humble opinion with the facts you state

        that covered California gave you one amount and HealthNet thanks you know a different amount

        and we’re talking about proofs here

        I don’t think you’re gonna win

        I really feel that you got to do this like a court case and submit your documentation that proves your point

        I’m not an attorney I can’t give you legal advice

        I just haven’t seen that many appeals come out in the clients favor

        Reply
    4. Steve Shorr says:

      Are you sure it was Department of social services or do you mean Department of managed healthcare or department of insurance I don’t see that department of social services has anything to do with it

      I don’t know of any law or precedent to allow you to start July 1 if you have that please post it here because it will teach me something new would be helpful to other site visitors

      When you say take it to a judge do you mean go to small claims court superior court or in and made a straight of law judge in the appeal section of covered California or Department of insurance I’m using my iPhone now so I can’t put in all the links that I’d like to but if you search for appeals on this website you can find everything that I have but don’t forget you’ve got to show all the proofs and you’re going to have to show that you were never properly canceled and have proof I’m not an attorney so please doublecheck everything that’s not cited

      Reply
      • Steve Shorr says:

        I guess you’re right because Medi-Cal is part of the department of public social services

        also if you can show a material violation or error then that would get you new enrollment.

        So your policy would be not reinstated it would be a brand-new special moment.

        Any be able to pick any plan and then you can appoint a says your age and we can get it going for you and that way we get paid for helping you rather than just is a public service

        In the menu above put your mouse over special enrollment and then look for material violation

        Reply
    5. Anthony says:

      Hi Steve,
      Thank for responding back to me. Today I called CA Department of Social Services and submitted an appeal for being wrongfully cancelled and asked that I be reinstated starting July 1st. Since I will be reinstated July 1st, i will not have to back pay for the months I did not have coverage. The back pay is more than the federal fee for not having health insurance. I will gladly pay the federal fee.

      If for some reason, Covered CA and Healthnet can not resolve this issue I will have to present my case to a judge and he will decide.

      Thanks again for your time and all the great resources you have provided me.

      Anthony

      Reply
  3. 3 comments on “Narrow Networks – 3 month grace period”

    1. Anonymous says:

      I have Blue Shield Silver 1850 PPO individual and family plan- it is not covered California. I have had 3 different offices turn down our health insurance because they said it was a “mirrored plan” to covered California.

      Does covered California actually have a matching plan or are these people just misguided?

      Reply
      • See the above page about the rules, laws and mandates that plans offered in Covered CA must also be offered outside of Covered CA too. I think your question really is, how do I find a participating MD.

        Reply
        • See our page on Scarpo vs Blue Shield alleging that bogus doctor listed were knowingly provided to the public.

          See our general page on finding a provider. On this page, there are also links on how to use each specific companies provider list.

          If your MD’s are on the list, but they say they won’t treat you, let us know and we can look into appeals, grievances, etc.

          Reply
  4. 11 comments on “Was the cancellation #legal ? Web Visitor Q & A”

    1. Question

       

      I got a refund check in the mail the other day. I called BCBS and they said it was a refund because I was late on a payment. I never received a cancellation letterI never received bills from them either so that gave me no indication that my insurance had been cancelled. They said they realized this after they had an audit.

      Any suggestions would be appreciated.

      Our Reply

      The specimen policy on page 39 deals with grace periods. The policy says may terminate, rather than shall. That’s in your favor. Of course, I’m not an attorney and am unauthorized to advise on contract law.

      I think you are going to wind up in a he said, she said situation with proving or not proving that late notices and your premium payments were sent or not sent.  Were your checks cashed?

      What dates does Blue Cross say they sent you late notices? US Mail or Email?  What proof do they have they sent them.

      According to the policy, you lapse 30 days after the late notice, not 30 days after premium was due.

      See page 151 for more information on how to file a grievance.  The policy says that you must provide ALL pertinent information and the details and circumstances of your concern or problem.

      As an authorized agent, we help our clients with filing appeals, reinstatements, communications problems as a complimentary service as we are paid by the Insurance Companies to consult, enroll and service our clients.  Here’s instructions to appoint us in CA.

      ***

      I just received a notice that my Anthem (non-exchange) policy was terminated because of lack of payment for February.
      filed an appeal based on the fact that I thought that auto-payment had been set up.

      Anything else I can do?

      Will they reinstate my policy?

      What documentation do you have to show that you had cause to think the auto pay was set up? Think of an appeal as a court case in front of an Administrative Law Judge. What evidence do you have? See our appeals page. If Blue Cross says no, do you have enough evidence to take this issue to Department of Managed Health Care?

      The Blue Cross manual makes lapsing for non-pay look like a black and white issue of no reinstatements.

      What does your Blue Cross Member portal show?

      Do you have a copy of the automatic premium payment form that you filled out? Proof that you sent it? Proof Blue Cross rec’d it?

      What about the alternate ways to pay premium?

      There are always temporary plans.

      Do you have an special circumstances to qualify for a special enrollment?

      Question

      I don’t have any documentation supporting my assertion that I thought I had set up autopay.

      I thought I set it up online in the same area where monthly bills are paid.
      The tab concerning payments on the Anthem site is not available anymore.Any advise as to whether it is worthwhile to ride out the grievance process or should I move on to other options? One issue with that is I have a number of claims that have now been denied because the termination was effective Feb 1.

      Any idea what they look for in an appeal? Is it a mere formality?

      Our Reply 

      There aren’t really any other options. One plus in Health Care Reform is no medical questions, guaranteed issue and no pre-existing conditions clause. The downside is one can only enroll at certain times.
      I’m not an attorney, near as I can tell an appeal is like an informal court case. I suggest you prepare your appeal in the same manner. When were you notified of the termination? That might get your claims paid?

      I requested the Anthem agent to submit the info for my appeal/grievance in hopes of expediting the process. Based on what you have stated I may have been to simplistic in my grievance. Basically I said I thought I was in autopay and received no notice that the payment for February was past due. My first knowledge of the problem was when I received the termination letter. Hopefully they give me an answer within a couple days (they said that is possible)Termination letter was dated March 6. The denied claims are before that date.

      Do you mean the customer service representative or your agent, which doesn’t cost anything extra to have?See beginning of this page for information on how and what is needed to file an appeal.

      We are talking about February payment right? If it’s January it looks like you’re SOL as the grace period only applies after you’ve made your first payment. Things are really complicated under Health Care Reform. The policy says you shall be informed that you can apply for reinstatement with a new application, BUT they only take applications at Open Enrollment and Special Enrollment. Then it talks about your right to have the cancellation reviewed.

       

      Have you received confirmation that they are handling your grievance?

      On the other hand, since you don’t seem to have any documentation to prove your case, it appears you’re SOL. You might contact an attorney? Maybe there will be a class action lawsuit somewhere. However, Health Care Reform seems to allow cancellations. It’s the only underwriting left for the Insurance Companies…???

      Here’s Kaiser Foundation on late notices…

      BC/BS New Mexico

      Reply
    2. Anonymous says:

      I still don’t understand how the Insurance Companies financial mistake on a contract allows them to bill additional – for alleged past due premiums, that were not billed when they were supposed to be.

      (I deal with contracts as a Contractor on a weekly basis and this is not allowed)

      Reply
      • Please give us a citation where an Insurance Company that due to confusion in the renewal, can’t bill for a month, that wasn’t billed when it was supposed to be.

        Here’s the reference material we’ve found on this topic:

        One must read a contract, law, statue, rule or regulation 3 times. Then when you think you understand it, read it again.
        https://healthlaw.healthreformquotes.com/plain-meaning-rule/

        Guide to Contract Interpretation
        https://files.reedsmith.com/files/uploads/miscellany/A_Guide_to_Contract_Interpretation__July_2014_.pdf

        Excerpt of Group Agreement
        Due Date and Payment of Premiums

        The payment due date for each enrollment unit associated with Group will be reflected on the monthly membership invoice if applicable to Group (if not applicable, then as specified in writing by Health Plan). If Group does not pay Full Premiums by the first of the coverage month, the Premiums may include an additional administrative charge upon renewal. “Full Premiums” means 100 percent of monthly Premiums for all of the coverage issued to each enrolled Member, as set forth under “Calculating Premiums” in this “Premiums” section.

        Can the Insurance Company send a Invoice several months late?

        Well in short the answer is yes, unless more than six years have passed. The only regulations placing a time limit on collecting a genuine debt is the Limitation Act 1980.
        Although you have the right to invoice, where the invoice is over 6 months old we would recommend to include a covering letter apologising for the delay or simply calling your customer beforehand to discuss the matter. This is especially true if the invoice is for a large amount and could cause difficulties at their end when it finally appears!
        If they have been prudent then they should have accrued for this bill in their accounts, especially if it is a large amount. However for many businesses a late invoice may come as a shock when they receive the invoice. I do grant, this law is from England. If you have a better citation, let us know. https://www.mycreditcontrollers.co.uk/Articles/how-late-is-an-invoice-still-valid.html

        Reply
    3. Anonymous says:

      What if my Covered CA bill has my spouses name, but it’s ONLY me that’s covered?

      *********************************************************

      On Exchange records displays the name of the Responsible Party instead of the main applicant. The Responsible Party is the person who set up the Covered CA application and indicated that they are responsible for the payment and oversight of the account. Before the binder payment is processed, the Responsible Party name will show up on the Individual List Bill (ILB), but the SSN and DOB will show as the main applicant. The main applicant is different from the Responsible Party. This will typically happen when the Responsible Party applies for a dependent or a spouse through On Exchange Covered California plans. All correspondence sent out will be addressed to the Responsible Party, including the initial binder payment letter. Once the binder payment is processed, the main applicant and additional dependents will be visible. Blue Shield Email Dated 1.13.2013

      Reply
    4. Justus T says:

      Causing the cancellation of policies by not billing seems to be a common problem with Anthem. Check out the complaint by Roberta of Lyons, CO at https://www.consumeraffairs.com/insurance/anthem.html?page=15. I especially like the way Anthem cashed the check and then claimed they didn’t…

      Reply
      • Your citation is from 2006, why bother us on this website?

        Reply
    5. Justus T says:

      I have battled Anthem over a wrongful cancellation. I paid my premiums on time, sent certified mail so I know it was received, but Anthem apparently decided not to cash one and claimed that I owe it.

      According to Black’s law dictionary, payment is “The performance of a duty, promise, or obligation, or discharge of a debt or liability, by the delivery of money or other value. Also the money or other thing so delivered.” This means that the check doesn’t need to be cashed in order for the payment to be made; it means that the payment (check, money order, etc) only needs to be delivered. This makes sense. Your mortgage company couldn’t repossess your home by refusing to accept your payment.

      Further, the Uniform Commercial Code (Article 3) states that if you give someone a payment, and they refuse to accept it, your debt to that person is reduced by the amount of your payment. (paraphrased)

      Last but not least is the concept of good faith and fair dealing. In contract law, the implied covenant of good faith and fair dealing is a general presumption that the parties to a contract will deal with each other honestly, fairly, and in good faith, so as to not destroy the right of the other party or parties to receive the benefits of the contract. (Wikipedia). When I sent my payment and Anthem didn’t cash it, Anthem appeared to be acting in bad faith by denying me the benefits of having the insurance I had paid for (see point #1)

      Just a few thoughts on what’s happening……..

      Reply
      • Please, when citing things, put in a URL – Internet Address

        Reply
    6. Tricia & Greg A says:

      Found your name on website of anthem…..We have lost our coverage due to exceeding grace period time frame…..DEVASTATING….Anthem is going through process of reinstatement application but informed me it does not look good. Is their any hope? My husband and I are 61 years of age. what can we do? We pay $1,980.00 monthly in premiums.

      Reply
      • Tricia & Greg A says:

        Thank you for our conversation by phone this a.m. Please e-mail me whatever documents that may be able to assist me in getting reinstated with Anthem Healthkeepers Gold Richmond VA under Blue Cross Blue Shield

        Reply
      • Do you qualify for any special enrollment periods?

        How about a temporary plan? The time periods for coverage have become very limited though.

        Didn’t you get a late notice?

        Personally, I don’t like submitting appeals and grievances over the phone. You don’t know if the person taking the grievance really knows what they are doing or are looking out for your best interests. I suggest you put everything you have together and file your own grievance. Then if you get denied, you are all ready to give it to your attorney or the appropriate state agency to help you.

        So, basically, read everthing I have and follow the links in this section of the website and put together your best argument.

        Reply
  5. I didn’t pay my premium last year and got cancelled. I applied to the same insurance company this year, during open enrollment and got new coverage for 1.1.2020. They billed my for last years premium. Is that right? Legal? Enforceable? Do I have to pay it? Can they cancel 2020 coverage if I don’t pay it?

    • If your health insurance company ends your coverage because you didn’t pay all outstanding health insurance premium payments in full by the end of your grace period:

      When you apply [at Open Enrollment] and are found eligible to enroll in a Marketplace [Covered CA] plan, you may be able to enroll in the same plan [or another one] you lost if it’s still available. If your health insurance company has clearly described (in paper or electronic form) the consequences of non-payment on future enrollment before your loss of coverage, they may, in order to complete your enrollment, require you to pay any past-due premium amounts you owe them for coverage in the past 12 months. https://www.healthcare.gov/apply-and-enroll/health-insurance-grace-period/

  6. Help, I’m a victim of identify theft and there were phony checks written on my account. My bank changed my account # and thus auto pay was discontinued. My health insurance got cancelled. Is there a law or something to protect victims of identity theft, fraud, something???

  7. I’ve been purchasing my Kaiser through the covered ca marketplace the past 2 years. Been with them since 98 via employers, and even cobra coverages.

    I just got an email came that I’ve been terminated back to 3/31?

    I never received suspension or anything warning nothing.

    I do get subsidy too.

  8. My policy was canceled on April 1st for non payment.

    I have Blue Cross Blue Shield,

    ***In CA you must be more exact. Did you have Blue Cross in Northern CA or Blue Shield?

    I was paying $80/month
    ***Subsidies are great. Which also give you 90 days grace period as long as you paid January. Do you have proof of January payment?

    and it was not put on auto pay- I thought my agent put it on auto pay for me.

    ****Do you have any proof? Maybe we can get a special enrollment period https://individuals.healthreformquotes.com/open-enrollment-for-individuals-families/ccr-code-regulations-ca-§6504-special-enrollment-periods/ for company error?

    I am really concerned about this. I would love to be reinstated and am willing to pay fees and anything I need to to get this back.

    ***Please appoint us as your agent with Covered CA https://healthreformquotes.com/15-reasons/covered-ca-agent-appointment-instructions/ We can’t make any promises, it’s a very difficult thing to get reinstated.

    We will do our best. If all else fails, there are temporary plans. https://individuals.healthreformquotes.com/open-enrollment-for-individuals-families/short-term-temporary-plans/
    Please advise and help!

    We answered this one in interlineation…. rather than Q & A

  9. I was just cancelled by Kaiser for Non-Payment. They are reviewing my file.

    1. Are you available on the weekends to review and advise me by telephone?

    2. Can my wife, son, daughter, friend listen in and ask questions?

  10. Hello,

    I hope you can help me. I have Anthem blue cross. It happened, that I missed the payment for July, but I did make the payment, but apparently it didn’t go through. So I was about to make a payment today and found out that my payment was due July 1st. I messaged them, thinking it was a system mistake, but that is what I got back; ( I haven’t received any warning letters from Anthem either):

    Dear Ms. R:

    “Thank you for your e-mail inquiry dated 08/03/2017. I’m glad you wrote to us today so that we can take care of this right away. Our records show the last payment received was on 6/6/2017 and was applied to the June premium. No other payments were received. Late payment letter was sent 6/30/2017 advising should the July payment not be received by the end of July the policy would cancel. No payment was received and regretfully your coverage was terminated effective July 1st. ”

    Any way I can get it back if I pay the balance now or any other possible way to get me covered till the next enrollment? I am not qualified for medicare.

    Appreciate your help,

  11. Steve

    I have an Anthem policy with the 90 day grace period running out on July 31. I’m on unemployment and won’t have the funds to bring current until August 7.

    Is there any possible solution that will keep the policy from terminating?

    Thank you,

    • How about if you beg or borrow May’s premium and pay that now? That ought to keep you current, as you’ve paid May. June and July premiums should still have 30 and 60 days to go.

      Here’s instructions to appoint us as your agent. We can then check your exact payment status and seek out more possibilities to resolve your situation.

      You might also take a picture with your smart phone of all the invoices and relevant documents. Then email those to us.

      What is your estimated MAGI income for 2017? Medi-Cal might be available if under $17k.

  12. I’m not sure if this is the place to ask this question, but thought I would try. I live in Oregon and have purchased my health insurance directly from healthnet the entire time. I got no subsidies, and did not use the Exchange.

    On April 18 I paid 2 months of premiums at once (April & May),.

    I learned on April 25th when I tried to get a medication refill, that my coverage had been cancelled for non-payment. Apparently April 15th is the grace period cutoff. I always thought it was the 18th, but I’ve always paid it earlier anyway. I appealed the case on the same day, April 25, and today I found out that my appeal is DENIED. Also, I am not able to purchase new insurance until November 1, 2017.

    After all these years, I paid 3 days late and they kicked me off insurance? How can that be legal?!

    • If you paid March, I don’t think your cancellation for non-pay on the 18th is legal. I’m basing this on CA Health & Safety Code 1365 (a) (1) (A)

      (a) An enrollment or a subscription shall not be canceled or not renewed except for the following reasons:

      (1) (A) For nonpayment of the required premiums by the individual, employer, or contractholder if the individual, employer, or contractholder has been duly notified and billed for the charge and at least a 30-day grace period has elapsed since the date of notification or, if longer, the period of time required for notice and any other requirements pursuant to Section 2703, 2712, or 2742 of the federal Public Health Service Act (42 U.S.C. Secs. 300gg-2, 300gg-12, and 300gg-42) and any subsequent rules or regulations has elapsed.

      Yes, I guess I could see where this is confusion. If the bill for April when out on March 15th, would that mean the 30 day grace is April 15th or 30 days after the March premium is used up on March 31st?

      Let’s check the Department of Managed Health Care Guidance Sorry, but that page must be copy protected. I can’t cut and paste here. So click on the prior link and review it yourself. I only research CA and Federal Law, please check with a competent Insurance Agent in Oregon, your Insurance Commissioner or an attorney. In CA the guidance says that the grace period only would start after the March premium is used up.

      Here’s our page on appeals & grievances – for general reference.

  13. I made my Jan payment on 31st of Dec. I made it through doxo support. It was a Saturday . So they sent it again on Jan. 2nd. It left doxo at 8:45am and Anthem verified it on the same day at 2:08.

    I have called and waited over and over and then I sent to the office who does not do that. Even Headquarters in Massachusetts did that today.

    My name is Rhonda W
    . My ID is xxx or x. I used the 6 because it had a pad of numbers and not letters.

    Can you please call me at xxx?

    My financial discount for January is $598.00.

    • I really can’t help you. I only represent Anthem in CA. Also, I’m not your agent so they won’t do anything for me. Privacy and all. I did forward you inquiry, but I doubt anything will happen. Did your check clear the bank? Try sending WRITTEN proofs via certified mail.

  14. I HAVE BLUE CROSS C PLUS;;

    I WILL HAVE NEW PROVIDER IN JAN. OF 2017;

    DO I HAVE TO PAY THE LAST PAYMENT IN DEC. OF 2016 TO BLUE CROSS;;

    NEW COVERAGE STARTS IN JAN. 2017 WITH HUMANA

        • I’m insulted that I’m even asked this kind of a question.

          As a licensed agent, I’m mandated to take an ethics class every two years, in addition to each Insurance Companies Code of Ethics, AHIP training – Fraud, and of course what I learned in Boy Scouts and Sunday School.

          Using a CA Blue Cross Evidence of Coverage as an example on page 200 says when you are allowed to leave a Medicare Advantage Plan… I don’t see getting coverage in January as a reason to leave in December.

          Plan C is not a California Plan, you are going to have to check with Blue Cross in your State. IMHO you owe the money, Blue Cross could take you to Small Claims Court for it.

          What are you going to do if you have a claim?

          Excerpt from page 20

          We have the right to pursue collection of the … amount you owe. In the future, if you want to enroll again in our plan (or another plan that we offer), you will need to pay the amount you owe before you can enroll.

          Why do so many people expect Insurance Companies to promptly pay claims, but want to get a free months coverage? It’s a two way street.

          Medicare Advantage plans are highly regulated by CMS!

          Only paying the premium, if you have a claim, violates basic principles of Insurance.

          pooling funds from many insured entities (known as exposures) to pay for the losses that some may incur. The insured entities are therefore protected from risk for a fee, with the fee being dependent upon the frequency and severity of the event occurring. In order to be an insurable risk, the risk insured against must meet certain characteristics. Learn More ===>wikipedia

  15. Hi Steve
    What happened to our health care savings of $2000/year per family? LOL
    Pray that Trump gets elected and that he puts our health care system back to what it was and makes real healthcare reform without these blood sucking so called providers.
    Rhode Island

  16. Paid the first months premium. Never got an invoice for future months premiums.

    *****We’ve copied and will respond to this comment – question, on this new webpage.

  17. I never received a cancellation letter. I never received bills from them either so that gave me no indication that my insurance had been cancelled.

  18. Hello…

    1. I was cancelled by Kaiser (terminated) owing 4 payments totaling 1400.00…

    2. i will turn 65 on Oct. 2nd…

    3. there is no way to pay a lump sum like that on a fixed income…

    4. will i have to go to county hosp. for treatment and perscriptions… i am a heart patient with 3 seperate heart issues…

    Thank You for any help you can answer to me…

    sincerely Theresa.

  19. Question about dental insurance through CC. I have Anthem BC/BS and my policy was canceled after 30 days of non-payment. But above you state that the grace period is 90 days for CC. Was my policy canceled too early?

  20. Dear Mr. Shorr,

    HELP!!

    I had no idea what I was in for with the California Care mess. I went to a broker that seemed to have my best interest in mind.

    She however, failed to explain all the pros and cons about auto pay vs billing and what happens if you are late. What a mess and what a RIP OFF this Cal Care “thing” is.

    Unless I come up with $ 7….. 00 off dollars I will be cancelled. This is such a nefarious structure.

    Please help.

    B.T.Y: I’m referring to to my Blue Shield PPO plan.

    Maia

    • What is your question for me and how would you like me to help?

      What is the cancellation date?

      Please take a picture with your smart phone of all relevant documents and email those to me

      Please go into your covered California account and in the upper right-hand corner where it says find help appointment as your agent so I can check that account and see how I can help you you may have to manage delegations and take off the other agent

      • What wd be your benefit in helping? Your fee we be?

        Help me get them to stop denying my visits as I’m paying down the $700.00 off $$.

        My policy started in Jan in Feb I didn’t realize she had me on auto pay.

        They surprisingly took $185. – $190.00 out & really messed up my accnt. I requested regular billing

        • Take a look at my website, my bio, the testimonials the role of an agent, etc. I help a lot of my clients, with the background, experience, education and training. The law states that you are entitled to buy direct from Covered CA, Blue Shield or through an agent at the SAME price! 42 U.S. Code § 18021 Thus there is no fee as long as you appoint us as your agent. Here’s instructions.

          As soon as you appoint us as your agent, both with Blue Shield and Covered CA we can look into your account and see what we can do on getting a payment plan. It will be difficult though. If it was easy, they would have done it for you already.

          I’m confused on what your monthly premium was. How much was the subsidy and how could auto pay mess you up. They should have taken out the full premium that you owe, minus the APTC Advance Premium Tax Credit. Please take a photo off all relevant documents, all invoices & proof of payment, etc. and privately email them to me. Please also use our FREE quote engine which includes a subsidy calculation.

          Do you have an online account with Blue Shield? Send us your user name & password too, so that we can get the information to get your issues resolved.

          • Please note also that when you get the free quote it will calculate if you get free Medi-Cal and that’s basically if you’re Maggie income is less than 138% of federal poverty level or about $16,800

            When you qualify for Medi-Cal that’s direct through the county social service agency We don’t get paid to help you with that

            covered California should’ve already told Medi-Cal that you’re eligible for Medi-Cal. Medi-Cal should be contacting you directly for enrollment. Medi-Cal also has a rule that they cover you once the application process starts. So, even if you don’t have your Medi-Cal card, they can probably pay your pending claims, if you went to a MD that accepts Medi-Cal.

            it sounds like the $190 deduction was for your net premium if you did qualify for covered California assistance

            If you asked to pay for private insurance then you have to pay the full premium, no subsidies. So, if you qualify for Medi-Cal you can’t get a subsidy for the full premium. Just take the Medi-Cal no premium. Check around and see if you can find a better job or get another part time job to boost your earnings.

  21. I had BC/BS ppo in FL. High premiums forced me to look elsewhere. United Health sold me short term insurance without giving me all details – full disclosure. They told me to cancel BC/BS.

    I did and now I have no major medical. [or coverage to meet the 10 minimum essential benefits or mandate – shared responsibility requirement.] THe BC/BS premium was paid same day I cancelled. Can I get reinstated with BC/BS.

    • It would be a tough fight, but IMHO and you might want to check with legal counsel… you may be entitled to a special enrollment or reinstatement under Section 4 of CFR § 155.420

      (4) The qualified individual’s or his or her dependent’s, enrollment or non-enrollment in a QHP [Qualified Health Plan] is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, misconduct, or inaction of an officer, employee, or agent of the Exchange or HHS, its instrumentalities, or a non-Exchange entity providing enrollment assistance or conducting enrollment activities.

      For purposes of this provision, misconduct includes the failure to comply with applicable standards under this part, part 156 of this subchapter, or other applicable Federal or State laws as determined by the Exchange.

      Also, IMHO BC/BS ought to have told you that the Short Term Policy was not qualifying coverage, when you sent them a copy of the ID card to cancel.

  22. We got behind on our monthly payments due to taxes. We continued to pay the monthly premiums plus an additional $40.00 per month to address the unpaid balance due. The last payment the Public Employees Benefit board received was Feb 6th, 2016.

    Although we make our payments via home computer for our online banking account, for some reason a payment on Feb 26th, 2016 was not transmitted.

    We missed a payment we thought we made at the end of February. Our insurance was cancelled on March 23, 2016 with a cancellation date of 12,29,2015.

    I had surgery on Feb 29th, 2016. Now we have bills exceeding 120,000.00 for expenses from Jan 2016 to the present.

    • What state are you in? I’m not an agent for the Public Employees Benefit Board http://www.hca.wa.gov/pebb/Pages/index.aspx I can only suggest that you file an appeal. Did you actually make the payment at the end of February? Will your bill paying service assist you? This is why, when we remember, we insist that everyone put their payments on auto pay.

      Did you get permission from anyone at the public employees board to pay $40/month to make up arrearages?

      You might check into Medi-Cal – Medicaid??? Share of Cost?

      Did you get any other late notices or cancellation warnings?

      Check the FULL policy, EOC – Evidence of Coverage here’s a specimen and see what the rules are on cancellation and notice.

  23. Got coverage through Covered CA starting February, and my old Blue Cross PPO got terminated due to non payment (on purpose.) Now Blue Cross demanding me to pay the 30 day grace period premium for the month of February of else they will take it to collections. I got Covered CA because Blue Cross was too expensive.. do I still have to pay February premium?

    • I suggest that you send a copy of your ID card, invoice, etc. what ever you have to prove that you have new coverage effective for February. Then Blue Cross should cancel for February. If you don’t have proof get it. If you don’t have new coverage pay the bill. Coverage is mandated and Blue Cross has to issue a 1095 B for your taxes.

      Learn more in specimen policy page 39 grace periods 142 it doesn’t appear to have a co-ordination clause with other insurance, thus you could turn in claims and get paid in full from TWO companies! Termination Page 33 your supposed to give notice Note that coverage also terminates when you are not longer eligible. Page 25 #8 can’t be covered by another group or individual plan.

      Thus, we not only answered your question, but have shown you the advantage of having a certified agent, with years of experience and tons of education to show you where the information is in the actual policy – contact. Please click on the link above in the menu on how to appoint us as your Covered Ca agent so that we can get paid for helping you, at NO additional cost to you!

  24. 1 My mom and dad were both covered under my dad’s insurance plan (Covered California subsidy)

    2 through his employer in 2015, until the end of October, when his employer suddenly switched insurance companies and provided each employee with a short cancellation letter for them to fill in and mail out to the insurance company they were leaving..

    3 My dad didn’t notice only his name (and not my mom’s) was on the letter and sent it out that way. His policy was apparently cancelled, but my mom’s wasn’t, so her bills kept coming in for the last couple months. Upon learning she was still being billed, I called my mom’s insurance provider to cancel. They said to call Covered Callifornia to cancel. I called Covered California and they told me that the insurance provider would cancel.

    4 I was very frustrated didn’t know what to do. A day later I called both the insurance provider and Covered California again and explained the situation and how I was being given the runaround and both told me to simply stop paying the bill, which would cause the policy to be cancelled automatically.

    5 Of course, this didn’t help and the insurance provider has sent numerous notices asking for payment for November and December 2015 (my mom has insurance again as of January 2016, with another provider), and the last one has threatened to send the bill to collections.

    6 What can be done??

    7 I did what I could and after reading up a bit more on this, it seems a cancellation letter was the way to go, but even so, it probably takes a couple months for it to be effective, so what would be the point?

    8 Any help on this would be greatly appreciated.

    9 My parents have a nearly perfect credit history and getting a bill sent to collections will really mess it up, but don’t want them to pay if it’s not their fault or required, since it seems that even employees working for the insurance company and Covered California aren’t sure about how to go about this. If they’re in the dark, how are we supposed to know?

    • 2 First of all, it’s a tax violation to have individual plans through an employer Learn More ==> IRS Notice 2013-54 It sounds like your employer learned this rule and put in a bonafide group plan.

      5 However, it sounds like the employer is trying to finagle the 9.5% affordabilty rule So, since your Dad apparently has affordable coverage, your Mom is not eligibile for subsidies. It sounds like your Mom was NOT on the group plan. Is that right?

      6 If your Mom has other coverage for November and December, send the proof to Covered CA and the prior Insurance Company and it shouldn’t be a problem to cancel. If not, pay the bill. She’s mandated to have coverage.

      By the way, as Certified Agent, I only get paid for maintaining this website and researching answers, when I’m appointed as your agent, no charge. Here’s instructions.

      Q & A is generally anonymous, let me know if you want me to edit out your “real” avatar.

  25. Great blog!!

    I’m a knucklehead. (True story): Paid January monthly premium ($875.00) for my Blue Cross policy. Then, pipe broke upstairs in my house, flooding most of my house, caving in kitchen and family room ceiling.

    Major household dislocation. Due to inside construction, literally FORGOT to pay Feb/March premiums. Received termination notice yesterday (March 18th) even though it was in my house in a pile of mail since March 10th. (Dated March 8th)

    Despite this obvious stupidity on me, can my policy be re-instated?? It’s a Saturday night, and, I can (obviously) contact them until Monday. I’m a self-employed stockbroker in a one man office. Very busy, but, obviously disorganized.

    Thanks!

    Thanks!

    • Unfortunately no. It doesn’t sound like you were getting Covered CA subsidies which would have given you a 90 day grace period. See links above for special enrollment periods and temporary plans. I’m doing what I can to get all my clients set up on auto pay, so this doesn’t happen. Do you have a non spousal employee you were thinking of hiring? That would get you the opportunity to purchase a group plan which has year around enrollment.

      • Hi….Thanks for quick reply. I live in Pennsylvania, but, have spent entire day tooling around the web and found your blog.

        I’ll call them 1st thing Monday morning with the (true) “dog ate my homework” story.

        Many Thanks, Steve……(We are in our late 50’s, good health…..does this mean we can’t get insurance??)

        • Not that I know of, other than a temporary plan. If you do learn of something I don’t know, please post it here. It could be possible that your state has more protection than the national rules or what CA has.

  26. I just received a notice that my Anthem (non-exchange) policy was terminated because of lack of payment for February. I filed an appeal based on the fact that I thought that auto-payment had been set up.

    Anything else I can do?

    Will they reinstate my policy?

  27. I just received a random letter today (March 7, 2016) from blue cross blue shield of alabama that said they canceled my policy for “non-payment” and that the effective date of this cancellation is January 1st. However, I set up auto pay and checked my account and I was billed and paid for January and February. What should I do? Can I be reinstated??

    • I’d like to see the letter and your proofs. Reading a letter at least 3 times can be very helpful. It sounds to me like you have a clear case for reinstatement. Try calling member support. Send an email to your agent and BC/BS. Check your policy – Evidence of Coverage for the appeal & grievance procedures. If that doesn’t work check with the Alabama Department of Insurance. See the links below for CA on grievance procedures and the link to the specimen policy grievance page.

      • Got it all resolved now! When I got the letter, I went into panic mood and started reading up on others that had this issue before. They did not have such a pleasant time getting reinstate. However, the lady I talked to was very helpful and fixed the issue!

  28. We had regular anthem blue cross for over a decade .

    Then when our premium went from $150 a month to 1500 a month we fell for the covered California trap

    at first it was hard because none of the doctors took it.

    It has gotten easier lately until the new year hit and I was supposed to get some sort of forms from anthem in the mail but I never received them. I am super busy and very stressed due to the fact that I have 5 kids 4 are still at home and my oldest is deployed with the Marines. I also work fulltime. I always paid the premium but since j didn’t receive the new amount in the mail I simply over looked it.

    My husband is having extreme depression, insomnia and anxiety . He went to the e.r and that is when I called anthem and found out my policy had been canceled .

    I begged them to believe me that I never received anything in the mail and to please re enstate the policy due to the fact that my husband is having serious health issues. That was on February 14th. They said they would file a grevance and I have called back twice and I have also called some emergency number out of Washington and left two desperate messages. I have heard nothing.

    Anthem told me I have to wait for something to come in the mail. I still haven’t recited anything. My husband need medical help badly.

    How can I get someone to call me back from anthem…

    • Were you getting subsidies from Covered CA? If so, that gives you a 90 day grace period. If not, I hate to say this, but you are SOL. Health Care Reform has the positive of giving everyone coverage, regardless of health, but on the other hand you can only buy coverage during Open Enrollment. Take a look on our page and see if you qualify for a Special Enrollment. Check our Grievance Page – Check the Specimen Policy for Grievance Procedures.

      Since you are with Covered CA, if you appoint us as your agent, we might be able to get you back in.

      Medi-Cal has some share of cost thing for the Uninsured? See also our webpage on Share of Cost and CHCF Foundations explanation. I don’t get paid for Medi-Cal so I’m not fully familiar with it.

      I doubt anyone will call you back. I don’t think there is a way to prove they didn’t send you a bill. On my grievance page, you can also complain to the Department of Insurance.

      • Yes, we were getting subsidies . I told them we were supposed to get a 90 day grace period but anthem said since they didn’t get our first of the years payment they didn’t have to give us a grace period.

        • If you appoint us as your Covered CA agent, I say we have a 35% chance of getting you coverage for April 1st. Did you have Covered CA and Blue Cross for 2015? It looks like Anthem is right about having to pay the 1st month premium. Learn More Health Affairs.org CFR 156.270 (d) (d) ECFR
          Grace period for recipients of advance payments of the premium tax credit.

          A QHP issuer must provide a grace period of three consecutive months if an enrollee receiving advance payments of the premium tax credit has previously
          paid at least one full month’s premium during the benefit year

        • She needs to file a complaint with Dept of Managed Health Care 1-888-466-2219 or Dept of Insurance 1-800-927-HELP. I believe Anthem is regulated by CDI not DMHC.

          MAX

          Editors Note – Max is also a top notch Insurance Agent and is on the DOI Educational Committee

      • I have a similar situation with a consumer who has Anthem Blue Cross. When the EPO plans in So. Cal. went to PPO plan, they were technically NEW plans and a Binder payment had to be made. For some reason, my client never received any new billing as his premium payments had always been drafted from his checking account.

        Long story short, Anthem is considering reinstating his plan to Jan. 1. Covered California did accept a SEP enrollment, but the plan doesn’t start until April 1. He is considering short term medical but he doesn’t know if Anthem will retro is plan or not.

        Editors note – Kevin is a top notch agent too

  29. I just started Molina…my first premium due the 25th…I won’t receive retirement check until the 29th. Will this be OK? Thank you!

    • Did you start February 1st or March 1st? Are you direct or through Covered CA? Are you getting subsidies? Did you want to appoint us as your agent, no charge? If February 1 – NO!!! per agent bulletin dated 2.17.2016 If you appoint us as your agent, we can check if you are good for March 1st. covered-ca/agent-designation/

      In your private email to us, you state it’s March 1, that should not be a problem. Again, if you appoint us as your agent, we can double check that.

      Covered CA payment methods – options

      45 CFR 155.240

      There has “always?” been say a 10 day time after the effective date to pay. It’s often been extended. Insure Me Kevin.com Appoint us as your agent and we will double check Molina’s deadline for March. Their deadline for February was yesterday, the 25th.

      Molina just issued an agent bulletin Friday 2.19.2016 12:19 PM stating the initial – binder payment for March is also extended to the 25th.

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