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Terms & Conditions

The information I gave on this application is true as far as I know. I know that I may be subject to a penalty if I do not tell the truth.

I understand that the information I give will be used only to see if those in my family who are applying for health insurance will qualify.

I understand that Covered California and the Medi-Cal program will keep my information private, as the law requires. For more information, or access to personal information in records maintained by Covered California and the Medi-Cal program, I can contact the Privacy Officer at 1-800-300-1506 (TTY: 1-888-889-4500).

I understand that to be eligible for Medi-Cal, I am required to apply for other income or benefits to which I or any member of my household is entitled, unless he or she has good cause for not doing so. Examples of such income or benefits are pensions, government benefits, retirement income, veterans’ benefits, annuities, disability benefits, Social Security benefits (also called OASDI or Old Age, Survivors, and Disability Insurance), and unemployment benefits. But such income or benefits do not include public assistance benefits, such as CalWORKs or CalFresh. If I have a question about a possible source of income, I can call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500) for help.

I know that I must tell Covered California or my county social services office about changes to anything I wrote on this application. To report changes, I can call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500) or visit CoveredCA.com. Or, I can call my county social services office.

I know that Covered California must not discriminate against me or anyone on this application because of race, color, national origin, religion, age, sex, sexual orientation, marital status, veteran’s status or disability. If I think Covered California has discriminated against me, including the failure to provide reasonable accommodations as required under state and federal law, I can make a complaint by visiting www.hhs.gov/ocr/office/file or http://oag.ca.gov/ contact/general-comment-question-or-complaint-form. If I believe that Covered California has discriminated against me or anyone else on this application in connection with a Medi-Cal eligibility determination, I can also file a complaint with the Department of Health Care Services, Office of Civil Rights by calling 1-916-440-7370 (TTY: 1-916-440-7399).

I understand that any changes in my information or information of any member(s) in the applicant’s household may affect the eligibility of other members of the household.

I confirm that no one applying for health insurance on this application is confined, after the disposition of charges (judgment), in a jail, prison, or similar penal institution or correctional facility. However, all inmates may apply for Medi-Cal regardless of their incarceration status.

I understand that I must report income changes to Covered California because it may affect the amount of premium assistance (or tax credits) that I may be eligible to receive. I also understand if I receive too much premium assistance (or tax credits) during the benefit year, I will have to repay the extra premium assistance back to the IRS when I file my federal income taxes for the benefit year.

I give my permission to Covered California to check other agencies’ computer records to verify citizenship, satisfactory immigration status, tax information, and other information related only to eligibility to see if I and other people on this application qualify for health insurance.

If someone on the application qualifies for Medi-Cal: I know that if Medi-Cal pays for a medical expense, any money I or anyone on this application get from other health insurance or legal settlements related to that expense will go to Medi-Cal as payment for the expense until the expense is paid in full.

For parents whose child or children qualify for Medi-Cal: I know I will be asked to help the agency that collects medical support from any parent on this application who does not live with the child and does not send support for the child. If I think that helping will harm me or my children, I can tell the Medi-Cal program and I will not have to help.

Your Right to Appeal

If I think Covered California or the Medi-Cal program has made a mistake, I can appeal its decision. To appeal means to tell someone at Covered California or the Medi-Cal program that I think its decision is wrong and ask for a fair review of the action. I know that I can find out how to appeal by calling 1-800-300-1506 (TTY: 1-888-889-4500). I know that I must file an appeal within 90 days of the decision. I know that I can represent myself or have someone else represent me in my appeal, such as an authorized representative, a friend, a relative, or a lawyer. I know that if I need help, someone at Covered California, the Medi-Cal program, or the county social services office can explain my case to me.

Privacy statement

This application is for health insurance through Covered California or for benefits through the Department of Health Care Services (DHCS). The personal and medical information you provide on it is private and confidential. Covered California or the Department of Health Care Services (DHCS) need it to identify you and the other people on this application and to administer our programs.

We will share your information with other state, federal and local agencies, contractors, health plans and programs only to enroll you in a plan or program, or to administer programs, and with other state and federal agencies as required by law.

You must answer all of the questions on this application unless they are marked “optional.” If your application is missing anything that we require we will contact you to get it. If you do not provide it, we will not be able to make a decision on your application. You may have to submit a new application, or you may not be able to get health insurance through Covered California, or your application for benefits may be denied.

In most cases, you have the right to see personal information about you that is in federal and state records. You can see it in an alternative format (such as large print) if you need that.

For more information or to see Covered California records, contact the Privacy Officer at:

Covered California

Attn: Privacy Officer

P.O. Box 989725

West Sacramento, CA 95798-9725

Phone: 1-800-300-1506

TTY: 1-888-889-4500

For the Department of Health Care Services, contact the Information Protection Unit at:

P.O. Box 997413, MS 4721

Sacramento, CA 95899-7413

Phone: 1-866-866-0602

TTY: 1-877-735-2929

These state and federal laws give us the right to collect and keep the information on the application: Covered CA: 42 U.S.C. § 18031; CA Government Code §§100502(k) and 100503(a). DHCS: CA Welfare and Institutions. Code § 14011 and Article 3, Chapters 5 and 7, Parts 2 and 3, Division 9. We must give you this Privacy Statement under CA Civil Code section 1798.17. You can see Covered California’s Privacy Policy by clicking here. See DHCS’ Notice of Privacy Practices by clicking here.

The information I gave on this application is true as far as I know. I know that I may be subject to a penalty if I do not tell the truth. I understand that the information I give will be used only to see if those in my family who are applying for health insurance will qualify. I understand that Covered California and the Medi-Cal program will keep my information private, as the law requires. For more information, or access to personal information in records maintained by Covered California and the Medi-Cal program, I can contact the Privacy Officer at 1-800-300-1506 (TTY: 1-888-889-4500). I understand that to be eligible for Medi-Cal, I am required to apply for other income or benefits to which I or any member of my household is entitled, unless he or she has good cause for not doing so. Examples of such income or benefits are pensions, government benefits, retirement income, veterans’ benefits, annuities, disability benefits, Social Security benefits (also called OASDI or Old Age, Survivors, and Disability Insurance), and unemployment benefits. But such income or benefits do not include public assistance benefits, such as CalWORKs or CalFresh. If I have a question about a possible source of income, I can call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500) for help. I know that I must tell Covered California or my county social services office about changes to anything I wrote on this application. To report changes, I can call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500) or visit CoveredCA.com. Or, I can call my county social services office. I know that Covered California must not discriminate against me or anyone on this application because of race, color, national origin, religion, age, sex, sexual orientation, marital status, veteran’s status or disability. If I think Covered California has discriminated against me, including the failure to provide reasonable accommodations as required under state and federal law, I can make a complaint by visiting www.hhs.gov/ocr/office/file or http://oag.ca.gov/ contact/general-comment-question-or-complaint-form. If I believe that Covered California has discriminated against me or anyone else on this application in connection with a Medi-Cal eligibility determination, I can also file a complaint with the Department of Health Care Services, Office of Civil Rights by calling 1-916-440-7370 (TTY: 1-916-440-7399). I understand that any changes in my information or information of any member(s) in the applicant’s household may affect the eligibility of other members of the household. I confirm that no one applying for health insurance on this application is confined, after the disposition of charges (judgment), in a jail, prison, or similar penal institution or correctional facility. However, all inmates may apply for Medi-Cal regardless of their incarceration status. I understand that I must report income changes to Covered California because it may affect the amount of premium assistance (or tax credits) that I may be eligible to receive. I also understand if I receive too much premium assistance (or tax credits) during the benefit year, I will have to repay the extra premium assistance back to the IRS when I file my federal income taxes for the benefit year. I give my permission to Covered California to check other agencies’ computer records to verify citizenship, satisfactory immigration status, tax information, and other information related only to eligibility to see if I and other people on this application qualify for health insurance. If someone on the application qualifies for Medi-Cal: I know that if Medi-Cal pays for a medical expense, any money I or anyone on this application get from other health insurance or legal settlements related to that expense will go to Medi-Cal as payment for the expense until the expense is paid in full. For parents whose child or children qualify for Medi-Cal: I know I will be asked to help the agency that collects medical support from any parent on this application who does not live with the child and does not send support for the child. If I think that helping will harm me or my children, I can tell the Medi-Cal program and I will not have to help.

Your Right to Appeal

If I think Covered California or the Medi-Cal program has made a mistake, I can appeal its decision. To appeal means to tell someone at Covered California or the Medi-Cal program that I think its decision is wrong and ask for a fair review of the action. I know that I can find out how to appeal by calling 1-800-300-1506 (TTY: 1-888-889-4500). I know that I must file an appeal within 90 days of the decision. I know that I can represent myself or have someone else represent me in my appeal, such as an authorized representative, a friend, a relative, or a lawyer. I know that if I need help, someone at Covered California, the Medi-Cal program, or the county social services office can explain my case to me.

Privacy statement

This application is for health insurance through Covered California or for benefits through the Department of Health Care Services (DHCS). The personal and medical information you provide on it is private and confidential. Covered California or the Department of Health Care Services (DHCS) need it to identify you and the other people on this application and to administer our programs. We will share your information with other state, federal and local agencies, contractors, health plans and programs only to enroll you in a plan or program, or to administer programs, and with other state and federal agencies as required by law. You must answer all of the questions on this application unless they are marked “optional.” If your application is missing anything that we require we will contact you to get it. If you do not provide it, we will not be able to make a decision on your application. You may have to submit a new application, or you may not be able to get health insurance through Covered California, or your application for benefits may be denied. In most cases, you have the right to see personal information about you that is in federal and state records. You can see it in an alternative format (such as large print) if you need that.

For more information or to see Covered California records, contact the Privacy Officer at:
Covered California Attn: Privacy Officer P.O. Box 989725 West Sacramento, CA 95798-9725 Phone: 1-800-300-1506 TTY: 1-888-889-4500
For the Department of Health Care Services, contact the Information Protection Unit at:
P.O. Box 997413, MS 4721 Sacramento, CA 95899-7413 Phone: 1-866-866-0602 TTY: 1-877-735-2929

These state and federal laws give us the right to collect and keep the information on the application: Covered CA: 42 U.S.C. § 18031; CA Government Code §§100502(k) and 100503(a). DHCS: CA Welfare and Institutions. Code § 14011 and Article 3, Chapters 5 and 7, Parts 2 and 3, Division 9. We must give you this Privacy Statement under CA Civil Code section 1798.17. You can see Covered California’s Privacy Policy by clicking here. See DHCS’ Notice of Privacy Practices by clicking here.

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Recent News

Common ERISA Penalties by the DOL – 2017

DOL image

The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.

The chart below shows some of the more common penalties assessed from DOL audits.

Failure to provide a summary of benefits and coverage$1,105 per employee
Failure to inform employees of CHIP coverage opportunities$112 per employee per day
Failure to comply with FMLA notice requirements$166 per employee per day
Failure to comply with certain GINA requirements$112 per employee per day
Failure to provide an SPD or plan document$110 per employee per day
Failure to provide documents to the DOL upon request$149 per day, not to exceed $1,496 per request
Failure to file an annual 5500 form$2,097 per day

The new ERISA penalties serve as important reminders to employers who sponsor benefit plans.  Many employers either think they are too small to be audited (not true), or that the medical carriers adhere to all the rules and furnish employees with what is required (not true).  It is for this reason that we have taken on the responsibility to protect our clients by providing them with the proper notices and instructions to maintain compliance.

Withdraw Dependent Coverage – COBRA Rules and the Pay or Play Provision

healthcare

With healthcare premiums continuously increasing year over year, many employers are searching for options to help reduce their benefit costs. A seemingly quick fix would be to eliminate dependent coverage, but you may want to consider eliminating dependent contribution rather than not offering coverage at all.

First and foremost, the circumstances are different for Small Groups in comparison to Applicable Large Employers. If you are considered an ALE, with 51 or more full time equivalent employees, then you are required to offer dependent coverage by law, or you may face an employer shared responsibility penalty. Please note that the definition for Small Group plans has been expanded to include up to 100 employees, so it is possible to be an Applicable Large Employer and still offer Small Group plans (51-100 employee size). Per the Affordable Care Act, and the ‘pay or play’ provision, the definition of ‘dependent’ only applies to children under the age of 26. Spouses are not considered dependents, nor are step children or foster children.

There are two types of penalties you may face if you do not offer proper coverage as an ALE.

  • If you DO NOT offer minimum essential coverage to at least 95% of your full time equivalent employees and their dependents then you may face a penalty if at least one of your employees obtains premium assistance from the public marketplace (Covered CA). If just one of your employees receives premium assistance, then you are liable for a $2,000 penalty for each employee, after the first 30 employees. [Total employees – 30, multiplied by $2,000]
  • If you DO offer minimum essential coverage to at least 95% of your full time equivalent employees and their dependents, then you may still be imposed a penalty if any employee receives premium assistance from the marketplace. If coverage is offered, but turns out to be unaffordable (more than 9.66% of household income), the employee has the option to purchase coverage and receive premium assistance. The employer in this instance will be penalized $3,000 for each employee that receives the premium tax credit.

If you are considered a Small Employer with 50 or less full time equivalent employees, then it is not a requirement for you to offer dependent coverage. If you elect to eliminate dependent coverage at renewal altogether, then you do not need to offer COBRA since terminating or amending the group health plan does not constitute a listed triggering event.

Dependents are only offered COBRA if:

  • Employment is terminated
  • Employee hours are reduced
  • Employee passes away, divorces, or legally separates
  • Employee obtains Medicare
  • Loss of dependent child status

SPD Requirements – Erisa Wrap Compliance

erisa

The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.  More often than not, a plan administrator assumes that a Certificate of Insurance qualifies as an SPD, and that either the insurance company or their broker is responsible for preparing and delivering SPD’s.  In this instance, the employer (plan administrator) is solely responsible for ERISA compliance.

An employer must have a written SPD, which serves as the main vehicle for communicating plan rights and obligations to participants and beneficiaries.  An SPD that includes the plan’s terms and conditions, such as a Certificate of Coverage, and includes (or ‘wraps’) it with the specific ERISA disclosure language is considered a ‘Wrap SPD.’  One step further would be to produce a mega-wrap document which would encompass all benefit lines into one document, which is HIPAA compliant as long as none of the benefits are self-funded.

ERISA requires that a SPD be distributed to enrolled participants within 90 days of coverage, or 120 days of a new plan being established.  If an SPD has not changed, an employer is required to furnish another copy to all participants every five years.

An example of some of the information required in an SPD:

  • Plan name
  • Employer’s name and address
  • Employer’s EIN
  • Plan Administrator’s name, address, and phone number
  • Type of plan and description of benefits
  • Effective and End Dates of the plan
  • Eligibility terms
  • How refunds are allocated to plan participants
  • Claims procedures
  • ERISA legal disclosure of participants’ rights
  • Sources of plan contributions
  • Details descriptions of plan provisions and exclusions
  • Information regarding COBRA, HIPAA, and other federal mandates
  • Summary of Benefits (SBC)

While it may be a bit overwhelming if your group is not currently in compliance – we are here to help.  We offer all of our clients a Wrap SPD that is co-developed and maintained by a major ERISA law firm, and has successfully passed DOL audits.

Feel free to contact us to ensure your group is in compliance.

Testimonials

Due to difficulties with the Covered California website, I thought I was never going to get healthcare coverage. I saw the website for Shop CA Brokers and the contact information. I connected with Bryan Bedrosian and now have health care. He sent me the application form for coverage and walked me through the entire process. He kept me up todate, along with giving me step by step instructions on the process. He was patient and informative. I highly recommend Ryan if you need any assistance!

Jane M.

San Francisco, CA

I spent a whole week trying to figure out how Obamacare actually worked through the Covered CA website. Just when I thought I had it all figured out with my subsidy and the plan I was going to choose, I DID NOT QUALIFY!  I couldn’t believe it, I spent at least 8 hours on the computer this past week doing everything I was requested to do, and in the end all it did was frustrate the living heck out of me.  I was about to give up and just go without insurance as I have in the past, but my wife randomly found the phone number to Benefit Agents and I was connect with Arman.  In 2 minutes he knew exactly what was wrong with my application and was able to walk me though the process of designating him as my agent.  He was then able to view my application through his computer and made the necessary fixes and got my wife and I enrolled.  5 minutes compared to 8 hours.  These guys deserve a lot more praise than any agent I’ve spoken to in the past.  5 star service, I highly recommend them to anyone.

Alex M.

Los Angeles, CA

I needed to have covered California insurance for my daughter and her family inasmuch is my son-in-law does not have the time to make the necessary inquiries due his work schedule. Ryan Bedrosian name came up on the computer screen and fortunately for me because he was able to facilitate the application to be submitted for covered California. Needless to say it was truly gut wrenching experience trying to contact covered California,however, we were able to resolve everything to my satisfaction. What I liked most was his willingness to accept all my phone calls, as busy as he is.

Martin C.

Palm Desert, CA

I submitted a new application on CoverCa website and was waiting for more than 3 weeks without any news or progress.

The application was stuck at Eligibility check stage. At that time I was desperate for help and called the CoverCa tool free number and waited over 1 hr and still cannot go thru. The same goes for their website’s chat that has 150 to 200 people waiting and would eventually kick you out of their system.

According to CoverCA health cost estimate tool, our family of 4 should be getting a few hundreds dollars of subsidies per month but after I went thru the whole online enrollment process at CoverCA, the system quoted me a ZERO subsidies per month!!!

So, thru. Google Ads, I found Bardia Farhadian from Benefit Agents. With my permission, he was able to see my case on his computer. He then step thru. all the info I have previously submitted and made a few minor but “critical” corrections.

Finally he performed the “M A G I C     T O U C H” by calling the broker’s dedicated support team / specialist inside of CoverCA and I got a call the next day with a Cover CA case number.

We were very happy that we also received the correct amount of subsidies and this alone is a great deal of money, over $4500 per year!!!

With this case number, I was told to wait about 5 days and call BlueCross for enrollment. I am now enrolled and have the peace of mind…

Overall, the process was very smooth, Mr. Farhadian was very professional and patient and informative. Thanks so much for your professional service!!!

p/s: He also saved me $400 (per year) plus for Auto Insurance!!!

I seldom give review but thru Yelp I was able to get very valuable consumer advises and save time filtering out the GOOD companies to do business with. Benefit Agents is definitely one of the good companies out there and one that will get the job done and save you a lot of $$$$ and time.

Joe A.

Rowland Heights, CA

If you have questions about Covered CA, the private insurance market or are thinking about making a change to your existing policy, then you need to call Ryan at SHOP CA Brokers.   He knows all the little details about Covered CA and the private insurance market that other agents won’t disclose to you or just do not know. I called at least five different San Francisco insurance agencies before I found Ryan. He streamlined the process in less than 15 minutes by asking if I qualified for subsidies through Covered CA. I am in between jobs at the moment and could still be unemployed in January 2014. At least I have the comfort of knowing that the government will help pay my premium if I cannot find work but then. In the meantime, Ryan helped me find a Blue Shield high-deductible HSA plan that is $130/month that will allow me to see all of my current doctors. Then toward the end of the year I will re-evaluate my situation. I am excited to have a new medical plan and wonderful new broker that will be there for me when my situation changes.

Also, it is important to note that Ryan did not try to push me off the phone when I kept asking questions.  I still email him from time to time to get his take on certain policy provisions and he still responds quickly (in less than an hour).  A+++++ Service.

Gwen O.

Oakland, CA

I’m so glad I selected Ryan to steer me through the process of signing my wife up for Obama Care via Covered CA. Even though the online enrollment process is FUBAR for both the federal and state sites I finally had success thanks to Ryan’s guidance.

Just as an example Covered CA asked for additional documentation regarding household income and citizenship for my wife who is Canadian. The site gave 3 methods  for providing this documentation: 1- Download to the site but the site does not have any provision to do so; 2- Snail mail (which wouldn’t work because the deadline for them receiving it was only 2 days from the date I received the request), and; 3- FAX it (but I have no access to a FAX machine since I am currently in Mexico)
.
Ryan’s solution to this dilemma was for me to send him the documents as an attachment to an email to him which is what I did. In turn he Faxed all 6 pages to Covered CA before the deadline and Kaiser was able to accept the first payment and my wife is now a member there.

Bob D.

Chula Vista, CA

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Platinum 90

Gold-80-2016

X
Gold 80

Gold-80-2016

X
Silver 70

Silver 70

X
Bronze HSA

Bronze-HSA-2016

X
Bronze 60

Bronze-60

X
Enhanced Silver 73 Policy

Silver 73

X
Enhanced Silver 87 Policy

Silver 87

X
Enhanced Silver 94 Policy

Silver 94

X
Eligibility Chart

Your FPL must be between 138%-400% to qualify.

FPL chart 2016

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Your FPL must be between 138% -400% to qualify.

FPL chart 2016

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Qualifying Life Events

A Qualifying Life Event would be considered:

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