HCC Short Term Medical - Missed Open Enrollment?
HCC Short Term Medical – Missed Open Enrollment?
Sample Appeal Letter - Missed Payment
Sample Appeal Letter – Missed Payment
Grace Periods from Agent ONLY Manual
Grace Periods from Agent ONLY Manual – Click to enlarge

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

OPEN Enrollment starts 11.1.2017 for 1.1.2018.  

The time frames will be very short, email us now, don’t wait!

Get ACA  Quotes & Coverage NOW!
Temporary Plan – Up to 3 months coverage, can be renewed!
Our Webpage on Temporary Plans

Gosh, I don’t know what it is, but this page is getting the most hits on the Individual Section of my websites.   If this page doesn’t answer your question, place it below in the questions section.

The Grace period under Heatlh 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.

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. 45 CFR 156.270  (d)

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.

This can be a real problem under AHCA – Donald Care with the continous coverage requirement, which then gives you a 30% surcharge.

Check out Special Enrollment – Change in Income,  Enhanced Silver (Cost Sharing Reductions)? *  Temporary Plans? * Proposed NEW CFR’s Special Enrollment

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.

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.

Here’s an example of how a three-month grace period works

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. And 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

Consequences of cancellation

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

Try a temporary plan or if you own a business – a group plan.

Payment options

We understand how difficult situations like this can be. We’re willing to work with members to help them, and we offer the following options to help make payments easier:

• 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.

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

Blue Cross – Ways to pay premium

Covered CA – Ways to pay

Appeals?  Grievances?

Check the FULL policy, EOC – Evidence of Coverage here’s a specimen and see what the rules are on cancellation and notice.  Then if you do decide to do an appeal, (page 151 in specimen policy or view our webpage)  you know what to argue about.

 

We’ve done these applications a couple of hundred times now. There is no charge for our service. Why bang your head?

Related Pages

Temporary Plans

 

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

  1. 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,

  2. 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.

  3. 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.

  4. 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.

        • 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

  5. 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

  6. 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.

  7. 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.

  8. 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.

  9. 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?

  10. 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.

  11. 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.

  12. 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.

  13. 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!

  14. 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.

  15. 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.

  16. 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?

  17. 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!

  18. 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

  19. 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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