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Delta Dental Quoting

Employer contribution entered in Dental Contribution under Group Information affects the Delta Dental plans and rates returned. Please be aware that Delta Dental will require groups with 100% employer contribution to have 100% participation.

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Individual Family Eligibility & Enrollment

If a couple has no income, can they qualify for Covered California?

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If the couple’s household income for the taxable year is below 138% of the federal poverty level, which it probably will be if they have no income, they may be eligible for Medi-Cal if they also meet the other eligibility requirements.

See pages 8-12 in the Eligibility for Individuals and Families participant guide.

If the couple is eligible for Medi-Cal they will not be able to receive premium assistance or a cost-sharing reduction through Covered California. However, they can buy a Covered California plan at full cost.

My clients with cancelled individual plans have questions about the recently announced eligibility for catastrophic plans. What can I tell them?

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See below a link to a recent Covered California FAQ on eligibility for catastrophic (aka minimum coverage) plans.
https://www.coveredca.com/FAQs/FAQ-PDFs/Exemptions_and_Min_Cov_FAQ.pdf

My clients enrolled in Covered California individual plans have questions about access to care starting Jan 1. What can I tell them?

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Covered California FAQs.

How can clients find out the status of their individual applications?

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See below a link to a Covered California Application Status FAQ:
https://www.coveredca.com/FAQs/FAQ-PDFs/Application_Status_FAQ.pdf

What can I provide to clients who are eligible for Medicare, but are interested in Covered California?

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See below a link to a Covered California Medicare FAQ:
https://www.coveredca.com/FAQs/FAQ-PDFs/FAQ_Medicare.pdf

An employee wants a different metal tier than is available to him through his employer’s Covered California for Small Business plan. Can he opt out and buy an individual Covered California plan?

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Yes, the employee can decline his employer’s coverage and purchase a Covered California individual plan. Agents should bear in mind:

Can an individual change the plan they are enrolled in mid-year?

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Plan changes can only be made during open enrollment, or during special enrollment periods after certain qualifying events.

For a list of qualifying events see page 6 of the module: “Eligibility for Individuals and Families” participant guide.

Are undocumented immigrants who file taxes eligible for Covered California?

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No, not unless they are a U.S. citizen, national or lawfully present.

If an individual enrolls in COBRA, can the individual switch to Covered California?

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If the individual enrolls in COBRA coverage and the special-enrollment period lapses, the individual cannot cancel the COBRA coverage and enroll in a Covered California health plan until 1) the COBRA coverage is exhausted, 2)  the individual has a different qualifying life event for special enrollment, or 3) the next annual open-enrollment period.

If the individual stops paying the COBRA premium and loses coverage (or if the employer has agreed to pay for a limited time and the individual does not continue the payments), the individual will not be eligible for special enrollment through Covered California. The individual will only qualify for special enrollment if:

  1. Someone else responsible for sending the COBRA premium payments (for example, the former employer) fails to do so on a timely basis.
  2. The individual moves out of the plan coverage area, and there is no COBRA continuation coverage available.
  3. The individual reaches the plan’s lifetime limit for benefits.

If none of these reasons apply, the individual will have to wait until the next Covered California open-enrollment period to cancel the COBRA plan and sign up for a Covered California health insurance plan, unless there is another qualifying life event for special enrollment. It’s also important to know that if the individual decides to drop or forgo COBRA and enroll in a Covered California plan, the individual cannot go back to COBRA.

Does moving into the State qualify as a qualifying event?

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Yes.