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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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

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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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