<p>Answer: If you are no longer covered by an outside insurance plan, you can cancel your Davis SHIP waiver and be enrolled in the plan at any point during the Fall, Winter or Spring terms. We do not allow students to cancel their waiver during Summer Session. You can fill out the Request to Cancel Waiver form and submit it to the Insurance Services office at the Student Health and Wellness Center. Your enrollment will be effective the day we receive the form. Your student account will be charged the entire Davis SHIP fee for the term that you enroll in, even if the term is already in progress."</p>
<p>They are aware of the UC insurance and I know they had registered son in the past. Not sure if they are signed p this year.</p>
<p>I am only repeating here what they were told by the CC reps. It seems like there are new products which are not understood and the validity of the information depends on the individual one happens to get on the phone. (that’s always been the case with insurance). She was told ‘sorry the last person gave you the wrong info’.</p>
<p>Calmom: I agree the one household one address makes little sense since kids can now be covered until the age of 26. Registering them all under the Davis address is indeed interesting. I imagine any system tying in the 1040 filing address and the address given for insurance purposes is not yet available for cross referencing. </p>
<p>As for CalPers… They are a public retirement system. There was a big bruhahah a while back where Calpers wanted Sutter to make public their charger rates. Calpers wanted their memebers to be able to see the different costs associated with health care. Sutter refused and was going to withdraw from the network. Of course this caused panic since in some regions they are the only game in town. Sutter then agreed to remain as long as a gag clause was put into place (as far as rates and contract). I bet the agreements Calpers is able to demand are very different than those a small family could extract. It is a prime example of the differences between group and individual plans.</p>
<p>Agreed that it is a major fail for BS. Not sure that ACA or Covered Cal would have any particular reason to anticipate the issue --a more reasonable interpretation of the EPO plans is that the network is co-extensive with the PPO network, with the difference being -0- out-of-network coverage for the EPO’s (as opposed to the restricted out-of-network coverage I get with my PPO – I can see the out-of-network doctor by my out-of-pocket maximum is +$3000 more if I do, plus of course no coverage for potential balance billing.) I mean, that goes back to the spare tire analogy: this seems to be a new, ad hoc restriction that has been imposed. </p>
<p>I think the insurance company is in the wrong here. Hence my suggestions about calls to the state insurance commission and the congressman. But the family needs to get their ducks in a row before making those calls.</p>
<p>Here’s something that you might try: call up the Blue Shield customer service number. Tell them that you have just moved to the area and are trying to select a plan. Say that you would like to get the EPO plan but you have two kids in college and want to know if they would be covered to get medical treatment in their college towns.Have one of your fictional college kids be attending school in a PPO county, and pick an EPO county for the other. (But don’t say Berkeley because Alameda county has its own set of confounding variables). Then see what the customer service person tells you. If they say, “oh yes, your kids will be covered” --then ask if there is a specific procedure you will need to follow to make sure they are covered. If they say, “no, they will have to come home to see the doctor” – then you can ask whatever questions you feel are appropriate. </p>
<p>Frankly I have to work up the energy to make the BS call. Mainly because the hold for new customers is still quite long. </p>
<p>As for the shared responsibility for this seeming loop hole, I do consider ACA partially responsible. New plans were created to contain costs and still provide the mandatory set of base coverages. The plans had to be approved by the State. California runs it’s own exchange. So, I’m assuming the State thinks this is an okee dokee plan to offer, and to make the disclosure requirements so lax that it is not possible to discern the limitations.</p>
<p>As someone who’s been figuring out health insurance for our family for many years, prior to ACA I KNEW they were hiding something. But, transparency was promised, side by side comparisons were promised…those promises will cause folks to let down their guard.</p>
<p>But we still don’t seem to have found anything in the plan itself that spells out this geographical limit. </p>
<p>If BS submitted documents to the state that failed to disclose in an unambiguous way that its EPO customers would not be allowed to receive services in other regions from BS-network providers – how would the state regulators know there was an issue requiring greater disclosure. This bit about the geographical limits seems to be a big departure from previous practice… so again, it comes back to the question: where is this limit written down?</p>
<p>Really, I think that the problem is more along the lines that BS is skirting the law rather than lax state authorities approving what they are doing. Your friend needs to push discussion with Covered Cal reps up the line – ask to talk to a supervisor and then the supervisor’s supervisor if necessary. The reps just aren’t particularly well trained – so they do often give out misinformation. </p>
<p>Calmom, I’m in complete agreement. I have put my friend in contact with a knowledgeable broker (H was trying to run defense between BS and CC all by himself). In exchange for making him broker on record (he get’s paid but it doesn’t cost the client) he’s willing to take on a fight if indicated. I’ve offered my assistance…and now…off to pick up kiddle one and wait for kiddle two to arrive…It’s mothers day weekend. </p>
<p>Calmom, if this had happened prior to Obamacare, you would have lambasted the insurance industry (including BS) and demanded govt regulation to rein in the insurance companies. Now that we have your govt regulation, the burden is all of a sudden on the consumer to unscramble the mess because the govt bureaucrats aren’t well trained. See the irony?</p>
<p>I seriously doubt the insurance companies are selling plans in violation of Covered Ca rules. The state is not opposed to these very restricted networks because they wanted to keep the premiums as cheap as possible. The state’s only concern was to get the enrollment numbers as high as possible; it wasn’t important to them to ensure sufficient access to providers for subscribers. I don’t envy Dietz’s friend because getting answers to this particular problem is going to be like pulling teeth.</p>
<p>I would agree with Calmom about the kid buying an Anthem plan directly from the insurance company without subsidies. I don’t see why that would be a problem even though he doesn’t have any income.</p>
<p>I have a new puzzle I need to solve and don’t know if someone here knows the answers.</p>
<p>One of our employees needed to pay Cigna on March 27th and his check bounced. He tried to pay last month and the system would not accept payment. They told him to start paying in May or something. Then today I found out that Cigna is refusing to accept payment at all and telling him the insurance is cancelled.</p>
I might be mistaken, but I don’t think that the IRS requires a home address. I know that I used my business address for tax filing for many years – so either I was wrong or IRS doesn’t care. </p>
<p>That doesn’t mean that the disclosure has to be easy-to-use. (It’s not really online – its just in the form of huge downloadable spread sheets). But it can’t be secret.</p>
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<p>Well, it isn’t small family vs. insurance company anymore. Now Covered California has the power to force changes as well. </p>
<p>Whatever problem your friend is having,it’s obviously not one that was anticipated. I think that if enough complaints are generated then there are going to be some changes made, whether the insurance companies want them or not. I haven’t looked into it, but there must be some mechanism whereby Covered Cal. is monitoring and accumulating data on various implementation problems as they arrive. </p>
<p>I simply don’t see where a restrictive interpretation of EPO plans is going to fly. I think its pretty fair to say that every insurance plan sold via Covered Cal. is also intended to provide coverage to all family members under the plan, even if some are are living, working, or attending schools in other regions. And it’s disingenuous for BS to say that they are incapable of providing such services in counties where they are operating PPO’s. </p>
<p>From the map, I think that BS opted to set up EPO’s in rural counties in order to prevent the residents from all flocking to the more expensive urban areas for all their medical needs. But that doesn’t change the fact that I still think they have an obligation to provide reasonable access to care for college kids living in different regions.</p>
<p>“I think its pretty fair to say that every insurance plan sold via Covered Cal. is also intended to provide coverage to all family members under the plan, even if some are are living, working, or attending schools in other regions.”</p>
<p>I’m sorry to say it, but I am very skeptical of, " They told him to start paying in May or something." </p>
<p>More likely they sent him a written notice of cancellation with a May deadline for payment to reinstate the policy… and he’s missed that deadline. (The deadline was more likely May 1 than any other date). </p>
<p>What is becoming clear here is that the navigators are not well trained. And worse yet, they have no liability or responsibility when false information, or materially incomplete information is given.</p>
<p>A common complaint about health insurance companies has been their lack of transparency, lack of useful (to the normal person) information sources and the practice of not receiving the full plan details until after one has signed and committed (when I buy travel insurance for example, I get 10 days to review the contract. When I purchase auto, life etc…I can review the contract after signing on and then cancel and change any time I want). So, despite all the hoopla about navigators and exchanges being a central and impartial source of information and a resource for consumers…they don’t seem to know what they are talking about. And, the information available to the end consumer, while now ‘standardized’ is no more transparent or available.</p>
<p>IMO the biggest mistake my friends made was to not go through a private broker. Funny, thing…when the exchange system was being designed the original plan was to exclude brokers from ‘selling’ these products. When one goes to a private individual there is a greater level of personal responsibility on both sides. When you run into a problem with an existing plan your broker on record - if they are good at what they do - will go to bat for you with the insurance company. The navigators - eh…sorry…got that one wrong buddy…call us in October…and since your still asking questions…we’ll probably give you some more bad information. NO accountability. It’s like when one calls the IRS and they phone rep reads from the rule book…and then says YOU must interpret what it means…so off to the private tax accountant whose bottom will be on the line when they sign off on your return. If this private accountant ‘interprets’ the IRS ruling wrong…well…then they will be on the hook as will their client. If the IRS phone rep gives misleading or materially incorrect info…oh well…better luck next time.</p>
<p>A local business contact got into the insurance business right when the ACA/ CC were being implemented. I spoke with him. If my friends make him their broker of record he will help them fight the case. There’s the prime example of what happens when one compensates for quality instead of simply keeping the chair warm.</p>
<p>Thanks for the link calmom. There have been some issues with verification and he had not received any subsidies although he is a citizen. It sounds like the 90 day grace does not apply when one is not receiving subsidies or am I reading it wrong?</p>
<p>^My policy states very clearly that I have only a 30-day grace period. Anthem did NOT send me a bill in February (the first month of our new plan). Yes, I should have noticed, but I pay lots of bills and missed that fact. In March, I received a notice that my policy would be canceled at the end of the month if I hadn’t paid. Kind of annoyed me. You sure have to stay on top of everything and not assume that other people are doing their job.</p>
<p>^ ML - based on the link, they can not cancel for non-payment for 90 days if someone is receiving subsidies. So if you get anything, Anthem should not have been able to do it.</p>
There’s also a motive on the part of the broker to sell you the product which is going to make him/her the highest commission, a product which may or may not be the best option for you.</p>