What if an Insurance Company or Covered CA makes a mistake,
Does that give you a chance to reenroll to fix the problem?

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 155.420Covered 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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