Health Insurance Open Enrollment in California 

Open Enrollment in California starts 11.1 and ends 1.31  AB 1309  *  CA Insurance Code 10963.5 *

We will have rates and benefits available on October 15th, see buttons above or below.


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SEP Special Enrollment Period Consumers Auto-Renewing for 2021

The renewal period [as opposed to brand new coverage] for 2021 coverage begins October 1.

After October 1, if you have NEW consumers purchasing coverage for the remainder of 2020 after experiencing a Qualifying Life Event (QLE) that triggers a Special Enrollment Period (SEP), and those consumers want to have 2021 coverage also, do not actively enroll them in 2021 coverage.

CalHEERS will process auto-renewals of existing 2020 enrollments, and actively purchasing 2021 coverage for a new enrollee who has purchased any portion of 2020 coverage after October 1 may create a duplicate enrollment or renewal fallout.

We will work on getting the above in plain English.  See button above or below for FAQ’s or email us  [email protected]  

 

Enrollments after the 14th of the month must acknowledge in writing that they understand they might not have their ID cards by the effective date.   Please don’t wait till the last minute!

Please note that CA now has an individual mandate penalty!  $695 per adult and $347.50 per child or  2.5 percent of your gross income that is above the filing threshold based on your tax filing status and number of dependents.

Subsidy eligibility for  APTC has increased from 400 to 600% of FPL Federal Poverty Level.

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California Insurance Code    10965.4  or 10965 – 10965.18 

(a) Notwithstanding paragraph (1) of subdivision (c) of Section 10965.3, with respect to individual health benefit plans offered outside of the Exchange, a health insurer shall provide an annual enrollment period for policy years beginning on or after January 1, 2020, from November 1 of the preceding calendar year, to January 31 of the benefit year, inclusive.

(b) Notwithstanding paragraph (3) of subdivision (c) of Section 10965.3, with respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2020, a health insurer shall provide a special enrollment period for all individuals selecting an individual health benefit plan through the Exchange from December 16 of the preceding calendar year, to January 31 of the benefit year, inclusive. An application for a health benefit plan submitted during this special enrollment period shall be treated the same as an application submitted during the annual open enrollment period.
 
(c) The effective date of coverage for plan selection made from December 16 to January 31, inclusive, shall be February 1 of the benefit year for individual health benefit plans offered outside and through the Exchange.
 
 
 
(a) A qualified individual may enroll in a QHP, or an enrollee may change QHPs, only during the initial open enrollment period, as specified in subdivision (b) of this section, the annual open enrollment period, as specified in subdivision (d) of this section, or a special enrollment period, as described in Section 6504, for which the qualified individual has been determined eligible.
 
(b) The initial open enrollment period begins October 1, 2013 and extends through March 31, 2014.
 
(c) Regular coverage effective dates for initial open enrollment period for a QHP selection received by the Exchange from a qualified individual:
 
(1) On or before December 23, 2013, shall be January 1, 2014;
 
(2) Between December 24, 2013 and December 31, 2013, shall be February 1, 2014;
 
(3) Between the first and fifteenth day of the month for any month between January 2014 and March 31, 2014, shall be the first day of the following month; and
 
(4) Between the sixteenth and last day of the month for any month between January 2014 and March 31, 2014, shall be the first day of the second following month.
 
(d) Annual open enrollment period for benefit years beginning:
 
(1) On January 1, 2015 begins on November 15, 2014 and extends through February 15, 2015.
 
(2) On or after January 1, 2016 begins on November 1, of the calendar year preceding the benefit year, and extends through January 31 of the benefit year.
***See above about changes in the Federal Health Care.Gov Exchange limiting open enrollment to 12.15.2017
 
(e) Beginning 2014, the Exchange shall provide a written annual open enrollment notification to each enrollee no earlier than the first day of the month before the open enrollment period begins and no later than the first day of the open enrollment period.
 
(f) Coverage effective dates are as follows:
 
(1) For the benefit year beginning on January 1, 2015, for a QHP selection received by the Exchange from a qualified individual:
 
(A) From November 15, 2014 through December 15, 2014, shall be January 1, 2015;
 
(B) From December 16, 2014 through January 15, 2015, shall be February 1, 2015; and
 
(C) From January 16, 2015 through February 15, 2015, shall be March 1, 2015.
 
(2) For the benefit year beginning on or after January 1, 2016, for a QHP selection received by the Exchange from a qualified individual:
 
(A) On or before December 15 of the calendar year preceding the benefit year, shall be January 1;
 
(B) From December 16 of the calendar year preceding the benefit year through January 15 of the benefit year, shall be February 1; and
 
(C) From January 16 through January 31 of the benefit year, shall be March 1.
 
(g) A qualified individual’s coverage shall be effectuated in accordance with the coverage effective dates specified in subdivisions (c) and (f) of this section if:
 
(1) The individual makes his or her initial premium payment, reduced by the APTC amount he or she is determined eligible for by the Exchange, by the premium payment due date, as defined in Section 6410 of Article 2 of this chapter; and
 
(2) The applicable QHP issuer receives such payment on or before such due date.
 
Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 CFR Section 155.410.

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Covered CA – Insurance Companies & Rates for 2018 – Preliminary – See Page 5 about CSR Cost Sharing Reductions

Covered CA - Insurance Companies & Rates for 2018 - Preliminary

 

 

AB 156 Individual Market – Enrollment Periods

 

LEGISLATIVE COUNSEL’S DIGEST

 
(1) Existing federal law, the Patient Protection and Affordable Care Act (PPACA), effective June 19, 2017, requires an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers to provide for the individual market an annual open enrollment period for policy years beginning on or after January 1, 2018, to begin on November 1 and extend through December 15 of the calendar year preceding the benefit year.
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Existing federal law establishes special enrollment periods during which a qualified individual may enroll in a qualified health plan when specified triggering events occur, such as when the qualified individual losses minimum essential coverage, as defined. Existing federal regulatory authority authorizes a state to establish additional special enrollment periods to supplement these special enrollment periods provided for under federal law under certain circumstances.
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Existing law establishes the California Health Benefit Exchange within state government for the purpose of facilitating the purchase of qualified health plans through the Exchange by qualified individuals and qualified small employers.
 .
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan and health insurer, on and after October 1, 2013, to offer, market, and sell all of the plan’s or health insurer’s health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan or insurer provides or arranges for the provision of health care services, as specified, but requires plans and insurers to limit enrollment in individual health benefit plans offered both through and outside of the Exchange to specified open enrollment and special enrollment periods.
 
Existing law requires a plan and health insurer to provide an annual enrollment period for policy years beginning on or after January 1, 2016, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive.
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Existing law requires a plan and health insurer, annually on or before October 1, to issue a notice to a subscriber and policyholder, as applicable, enrolled in any individual health benefit plan offered outside of the Exchange, and requires this notice to inform the subscriber and policyholder of, among other things, the applicable open enrollment period provided through the Exchange.
 .
This bill would instead require, with respect to individual health benefit plans offered outside of the Exchange, that the annual open enrollment period for policy years beginning on or after January 1, 2019, extend from October 15 of the preceding calendar year, to January 15 of the benefit year, inclusive.
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The bill would instead require, with respect to individual health benefit plans offered through the Exchange, that the annual open enrollment period for policy years beginning on or after January 1, 2019, extend from November 1 to December 15 of the preceding calendar year, inclusive. The bill would require a health care service plan and a health insurer, with respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, to provide a special enrollment period that will allow individuals to enroll in individual health benefit plans through the Exchange from October 15 to October 31 of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January 15 of the benefit year, inclusive, and would require an application for a health benefit plan submitted during this special enrollment period to be treated the same as an application submitted during the annual open enrollment period. The bill would require a plan and health insurer to also include in the annual notice described above information regarding the applicable special enrollment periods. The bill would make conforming changes.
 .
Because a willful violation of that requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.
 
(2) The PPACA creates various premium stabilization programs, such as the transitional reinsurance program and the risk adjustment program, to stabilize premiums in the individual market inside and outside of the Exchanges.
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Under the transitional reinsurance program, contributions are collected from contributing entities to fund reinsurance payments to issuers of nongrandfathered reinsurance-eligible individual market plans and the administrative costs of operating the reinsurance program for the 2014, 2015, and 2016 benefit years.
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Existing law requires a health care service plan and health insurer to consider the claims experience of all enrollees and all insureds in all nongrandfathered individual health benefit plans offered by that plan or insurer in this state as a single risk pool for rating purposes in the individual market and to consider the claims experience of all enrollees and all insureds in all nongrandfathered small group market plans offered by that plan or insurer in this state as a single risk pool for rating purposes in the small market.
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Existing law requires a plan and health insurer to establish, each calendar year, an index rate for those markets in the state based on the total combined claims costs for providing essential health benefits, as defined, within the single risk pool and requires the index rate to be adjusted on a marketwide basis based on the total expected marketwide payments and charges under the risk adjustment and reinsurance programs established for the state under the federal provisions described above and the Exchange user fees.
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Existing law requires the premium rate for all of the individual health benefit plans and small employer health benefit plans within the single risk pool to use the applicable marketwide adjusted index rate, as specified.
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This bill would delete the reference to the federal transitional reinsurance program in these provisions.
 .
(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
 

SEC. 3.

Section 1399.849 of the Health and Safety Code is amended to read:

 
1399.849 (c) (1)With respect to individual health benefit plans offered outside of the Exchange, a plan shall provide an initial open enrollment period from October 1, 2013, to March 31, 2014, inclusive, an annual enrollment period for the policy year beginning on January 1, 2015, from November 15, 2014, to February 15, 2015, inclusive, annual enrollment periods for policy years beginning on or after January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from October 15, of the preceding calendar year, to January 15 of the benefit year, inclusive.
.
(2) With respect to individual health benefit plans offered through the Exchange, a plan shall provide an annual enrollment period for the policy years beginning on January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from November 1 to December 15 of the preceding calendar year, inclusive.
.
(3) With respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, a plan shall provide a special enrollment period for all individuals selecting an individual health benefit plan through the Exchange from October 15 to October 31 of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January 15 of the benefit year, inclusive. An application for a health benefit plan submitted during these two special enrollment periods shall be treated the same as an application submitted during the annual open enrollment period. The effective date of coverage for plan selections made between October 15 and October 31, inclusive, shall be January 1 of the benefit year, and for plan selections made from December 16 to January 15, inclusive, shall be no later than February 1 of the benefit year.

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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

Historical

 

2020 Information

Covered CA and thus all carriers  has announced rates for 2020 which represent the lowest increase in premium ever at just 0.8%.   Get quotes here.   Then click here to set meeting time to review them.

PLEASE don’t go past December 12th if you want our professional help.  We have a life to live and don’t need the grief of erroneous enrollments!

In 2020, If you enroll between November 1 through December 15 * 20th – We just got a bulletin from Covered CAWHA, Blue Cross (Facebook post)  and Blue Shield, you get  a January 1, 2020 effective date. Covered CA bulletin 8.20.2019 *  December 16th through January 31, gets you a February 1st effective date.

2019  starts Oct. 15, 2018 to Jan. 15, 2019 * Covered CA Website *  CA Healthline 9.6.2017§6502 *Covered CA email dated 8.18.2017 * Los Angeles Times 10.8.2017 AB 156  *   

Covered CA has extended the deadline for February to Friday the 18th.   So has Sutter Email dated Mon 12/17/2018 8:37 AMOscar to the 31st   FaceBook *   Blue Shield  Email dated Fri 12/14/2018 9:04 AM   Western Health  Email dated 12/17/2018 4:32 PM  I expect all the other too under mirroring rules.

Open Enrollment for 2017, the period of time when you can start or change your plan for any reason, for Individuals & Families starts 11.1.2016 with a 1.1.2017 effective date as long as you apply by 12.15.2016, otherwise it’s the 1st of the next month as long as you apply by the 15th 1399.849 f 3 and runs through 1.31.2017  CMS rule. 9937 F

 

Covered CA has extended the January 1st Deadline to Friday 12.22.2018 Press Release  The February 1 to 1.19.2017  Letter to Consumers  

Health Care.gov –  Federal Rules, stop at 12.15.2017, with a 1.1.2018 effective date Modern Health Care 4.13.2017 * CMS.Gov 4.13.2017  * Amazonaws.com .

The shorted dates are to allevige concerns the Insurance Companies have about enrolling sick people at the last minute.

Explanations of the confusion in 2018 Open Enrollment:

Mercury News.com

Open Enrollment for 2016,  starts 11.1.2015 with a 1.1.2016  1399.849 f 3 and runs through 1.31.2016  CMS rule.

Covered CA extends Open Enrollment till the 17th!  CA Health Line

 

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