Dear Certified Agents:

I’m sure you share our excitement over the volume of consumer interest in California to sign up for affordable health care coverage through Covered California. This positive interest, however, has presented us with its own challenges. Helping consumers finalize the enrollment process is our key goal, and Covered California has developed a number of strategies to ultimately serve our consumers. As a Covered California Certified Insurance Agent, we’re impressed with your ability to reach and enroll consumers, as well as partner with us to resolve those challenges.

As we informed you last week, our challenge now is to process those paper applications. We have added additional resources and implemented many solutions to streamline the process of data entry. In addition, your assistance is needed to complete applications generated by your customers so we can ensure timely coverage.   The following outlines your role in finalizing these important applications.

Applications In Process: As the applications are processed by Covered California, agent delegations are being updated.  First and foremost, please remember to check your online portal several times a day for new delegations. Agents must accept the delegation in order for the agent to move the application forward. Once you accept the delegation, you will need to review applications for completeness, take the appropriate steps to obtain any required information, and complete any missing information using a copy of the paper application that you submitted.   If you do not have a copy of the paper application, contact your client to gather the remaining information. This will ensure that your client’s application is submitted and coverage is effectuated.

Non-Delegated Applications: If you have submitted paper applications but the delegations do not appear in your online portal, Covered California suggests you enter in the application yourself, as an option, to expedite processing.  Our service team will confirm that your client’s information has not already been submitted before entering data to reduce the number of duplicate applications.

In either case, please be mindful that there are certain areas of the application that need special attention.

These areas are as follows:

1. Sequence of Information – The online and paper applications do not necessarily flow in the same sequence.  Therefore, to complete the online application, you may need to find certain information on different pages of the paper application.

2. Applying for Financial Assistance – Consumers may request financial assistance (a.k.a., subsidy) to help pay for their health insurance or opt for no financial assistance.

If the paper application is for:

• Financial Assistance – The application will be 34 pages.  For these applications, you must answer “Yes” to the first question on the Apply for Benefits screen regarding the consumer’s desire to request financial assistance for their health insurance.

• Non-Financial Assistance – The application will be 6 pages.  For these applications, you must answer “No” to the first question on the Apply for Benefits screen regarding the consumer’s desire to request financial assistance for their health insurance.

3. Personal Tax Information – More information is requested on the “Personal Data – Tax Information” screen than is collected on the paper application.  When you get to the Tax Information screen, you will need to call the consumer to obtain the mandatory information to continue processing their application.

4. Tax Filing Status – To be eligible for APTC, married consumers must plan to file as “Married Filing Jointly” in the upcoming tax year.  If they plan to file under any other status (i.e., Married Filing Separately or Head of Household), then they will not be eligible for APTC.

However, there is an exception when married couples who are not legally divorced live apart in separate households for more than 6 months during a taxable year and one or both spouses are allowed to file a tax return as head of household (HOH) due to supporting a dependent child(ren) living in the same household as the spouse claiming the child.   In that case, the spouse filing as HOH can be eligible for APTC.

5. California Residency – While all programs require validation of a consumer’s identity to complete the application process, proof of California residency is only required if a consumer is determined eligible for MAGI Medi-Cal.

6. US Citizen Versus Naturalized Citizen – When completing the online application, it is important that you check either US Citizen or Naturalized Citizen but not both.

Covered California is offering a bridge line to assist in any technical issues that you might experience while completing these applications. The bridge line number is (703) 948-0488 and is available Monday through Friday, 9:00 a.m. – 5:30 p.m.  The conference ID is 850015584.

Note that if you are having problems with your passcode, resetting your pin,  accessing CalHEERS,  or any issues unrelated to  entering in a paper application using the online system, please contact the Agent Service Line at 877-453-9198.  DO NOT call the bridge line for these matters. 

Covered California will hold a training webinar next week regarding the differences between the online and paper application and to provide a refresher on the step-by-step instructions on how to complete and submit an application for the individual marketplace using our online system.  An announcement regarding that webinar with a link to register  will be sent out to you soon.

We want to encourage all of our Certified Insurance Agents to submit applications for the individual marketplace online and to refrain from sending in paper applications at this time.  The electronic processing of your client’s application will ensure expedient submission to the carrier for timely coverage effectuation.

Covered California appreciates our participation and looks forward to working together to improve the health of all Californians by assuring access to affordable, quality care.
Our success depends on the contribution of valued partners like you.  We thank you for your continued support.

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