What if an Insurance Company or Covered CA makes a mistake, error, etc.
Does that give you a chance to re-enroll to fix the problem?

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Enrolling in health plans through Covered California has helped people focus on their families and careers, and feel protected against unexpected medical issues.

Please start your research into Special Enrollment Periods by reviewing our main page of California Code of Regulations on Qualifying Events

(d) § 155.420  The Exchange must allow a qualified individual or enrollee, and, when specified below, his or her dependent, to enroll in or change from one QHP to another if one of the following triggering events occur:

(4) The qualified individual’s or his or her dependent’s, enrollment or non-enrollment in a QHP 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.

Pending Litigation and DOI Investigation – Narrow MD lists

Appeal ruling I found in a google search

(5) The enrollee or, his or her dependent adequately demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee;

(MD lists incorrect or not available?)

(Details 155.420

Covered CA NOT requiring documentation 

Oops, now they are

♦ Lawsuit alleging Fraud to gain market share  

Medical Provider drops out of Health Plan   

More 

[Rx not on Formulary?]

Resources & Links

Our Covered CA Appeals Page

Guaranteed Issue - No Pre X Clause
Quote & Subsidy Calculation 

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Missed Open Enrollment?
See our Special Enrollment page

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Detailed Video Instructions on using our 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

Covered CA Special Enrollment Rules & Job Aids

Covered CA's List of Special Enrollment Events

Covered CA's List of Special Enrollment Events - More than Direct with an insurance company

Proof of Eligibility for Special Enrollment webpage

SEP Video

HHS Video

Special Enrollment Tool Kit

2 comments on “Error – Material Violation by Insurance Company – Covered CA, etc.

  1. I let my Coverage go because President Trump said that it was no good, illegal, unconstituonal, etc. I now want to get coverage as CA has brought back the mandate penalty.

    Would this qualify as an error, material violation, etc. so that I don’t have to wait for open enrollment?

    • I think we have a good case. I’m almost positive that if we ask we will be told NO. Thus, we would have to file an appeal, that I don’t get paid any extra to help you on. I love the smell of napalm in the morning and a good legal battle… Thus, I’d be willing to fight this battle with you.

      IMHO the headline in the LA Times below, gives us a strong argument. If you want to pursue this, please research where else you believe you were mislead by an authorized entity. See above.

      obamacare unconstitutional

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