COVERED CALIFORNIA

The vision of the California Health Benefit Exchange is to improve the health of all Californians by assuring their access to affordable, high quality care.

The mission of the California Health Benefit Exchange is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.

Click here to visit the COVERED CALIFORNIA website.

Click here to learn about eligibility and enrollment into the Exchange .

 

Provider Education Grant Announcement

June 28, 2013

Covered California has released the application for the Provider Education Grants

Covered California announced the availability of grant funds for Health Care Professional Organizations to raise awareness of Covered California among the profession and encourage incorporating consumer education into the provider practice. This grant will be known as the Provider Education Grant and part of the Covered California Outreach and Education Grants Program.

Please click here for the grant application.

 

Outreach & Enrollment Grant Awards

May 14, 2013

Covered California™ today announced it intends to award grants totaling $37 million to 48 lead organizations. The grants will be used to conduct outreach and education programs on how, starting in 2014, Californians can access affordable health care coverage under the federal Patient Protection and Affordable Care Act. The lead organizations will be supported by 226 subcontracting entities.

 

Covered California FAQs

CPCA receives many questions about the California Health Benefit Exchange, now referred to as “Covered California”.  Answers to our most commonly asked questions are answered here

 

CPCA'S Current Covered California Advocacy and Updates

Posted July 18, 2013

Covered California Community Outreach Network

Covered California has released an interest form for those organizations who want to be a part of the Community Outreach Network.  This network will play a critical role in raising public awareness about the new health insurance marketplace.  Click here to access the form and submit via email to CommunityOutreachNetwork@covered.ca.gov

Posted July 1, 2013

CPCA Comments on CalHEERS Webinar

On June 18, Covered California hosted a webinar which provided stakeholders a first look at CalHEERS, the consumer-facing online portal for California’s new single streamlined application for health insurance affordability programs.  To view a recording of the webinar, click here.   To see CPCA’s comments on the June 18 webinar, please click here.

There should be more opportunities for stakeholders to view and comment on the development of CalHEERS prior to open enrollment in October.  Please check CPCA’s Weekly Update for announcements.

Posted June 26, 2013

At the last Covered California Board meeting on June 20,  Covered California staff presented the Board with a status update regarding the pediatric dental essential health benefit (EHB).  Several aspects of the update surprised CPCA staff and other stakeholders, and appeared to surprise the Covered California Board as well.

Most importantly, it was announced during the June meeting that the purchase of the pediatric dental benefit in the Exchange is to be optional and voluntary.   According to Covered California staff, federal and state law allows families with children to purchase coverage that does not include pediatric dental benefits, despite the fact that pediatric dental is a federally-designated essential health benefit.

Families who wish to purchase pediatric dental coverage through the Exchange will have the option to do so, but no federal subsidies will be available.  There will also be  a separate premium, deductible and separate out-of-pocket maximum for the pediatric dental EHB.

A requirement to purchase pediatric dental for children covered through Covered California may be added in future years.  In the meantime, CPCA and other stakeholders are exploring options to ensure that California’s children have access to dental coverage.  We will continue to update our members as we progress on this front.

On July 25, 2013, Covered California released the list of contracted pediatric dental plans.  Rate and plan information can be found here, and the press release is copied below.  Please contact Meaghan McCamman at mmccamman@cpca.org with any questions.

Press Release from Covered California:
COVERED CALIFORNIA ROLLS OUT PLANS FOR CHILDREN’S DENTAL COVERAGE
More Children Will Have Access to Improved Care Through a Diverse Choice of Plans, Products and Premiums

SACRAMENTO, Calif. — Covered California™ announced its selection of pediatric dental health plans, ensuring that California children up to 19 years old will get expanded opportunities for better dental health.

With its release of these plans and rates, Covered California took another step toward fulfilling the mandates of the historic federal health care reform law, the Patient Protection and Affordable Care Act, aimed at closing the health insurance gap for millions of Americans.

“These plans dovetail with our mission to make sure every person in the state — and particularly our youngest and most vulnerable — get improved health care,” said Covered California Executive Director Peter V. Lee.

The six selected companies are, Anthem Dental, Blue Shield of California, Delta Dental of California, Health Net Dental, LIBERTY Dental Plan and Premier Access Dental. The products include stand-alone plans, and all can be bundled with health insurance for a single premium.

Nine stand-alone plans are being offered by five issuers, while Health Net Dental is available only in a bundled option.

Three different product types are available, depending on where the child lives: dental health maintenance organizations (DHMOs), dental preferred provider organizations (DPPOs) and dental exclusive provider organizations (DEPOs). Like Covered California’s health insurance plans, the pediatric dental plans underwent a rigorous screening and competitive bidding process and had to balance access to providers with affordable premiums to qualify. 
The dental plans feature a diverse mix of large, multistate insurers and smaller, locally based companies. Stand-alone plan premiums range from less than $10 a month for an HMO plan in some areas to about $30 a month for a DPPO.

“Purchase of the pediatric dental benefit is not required. However, the plans offer comprehensive child dental coverage, particularly important for consumers of child-only coverage and family plans,” Lee said. “Dental care is a vital component of overall health, and especially critical for our state’s children. Access to dental services as a youngster means better health, both for children and as they get older.”

Covered California dental benefit plans feature standard copayments, deductibles and coinsurance requirements. Unlike Covered California’s health insurance plans, dental plans are not designated by metal levels, but come in two actuarial value options: 85 percent, which features higher premiums but lower average out-of-pocket costs; and a 70-percent value plan, with lower premiums and higher average out-of-pocket costs.

About Covered California
California was the first state to create a health benefit exchange following the passage of the federal health care law. Covered California is charged with creating a new insurance marketplace in which individuals and small businesses can get access to health insurance. With coverage starting in 2014, Covered California will help individuals compare health insurance plans and choose the plan that works best for their health needs and budget. Financial help will be available from the federal government to help reduce costs for people who qualify on a sliding scale. Small businesses will be able to purchase competitively priced health plans and offer their employees the ability to choose from an array of plans and may qualify for federal tax credits. Covered California is an independent part of state government whose job is to make the new market work for California’s consumers. It is overseen by a five-member board appointed by the governor and Legislature. For more information on Covered California, please visit www.CoveredCA.com

Posted May 1, 2013

Covered California Board Meeting
 

On Tuesday, April 23, the Covered California Board met in Sacramento to discuss supplemental benefits in the Exchange, CalHEERS, the Qualified Health Plan Model Contract, Eligibility and Enrollment progress and the Assisters program, among other topics.  Key takeaways from the meeting include:


1) Supplemental Benefits –  The Covered California Board had previously adopted policies which would allow stand-alone pediatric dental and vision plans to be sold in the Exchange in order to meet the pediatric dental and vision Essential Health Benefit (EHB) requirement.  They had also decided to allow the sale of supplemental adult dental benefits, and later added adult vision benefits in the Exchange.

However, On March 29, the Center for Consumer Information and Insurance Oversight (CCIIO), the federal Health Benefit Exchange oversight agency, released a guidance stating that an Exchange only may offer Qualified Health Plans, including stand-alone dental plans, to qualified individuals and qualified employers. This guidance has caused Covered California to revisit and re-evaluate some policies regarding ancillary services to comply with these new federal requirements.

Due to this new guidance, the Covered California staff has recommended the following policy regarding ancillary products in the Exchange:


Vision Benefits


• Offer pediatric vision benefits only through comprehensive Qualified Health Plans in 2014 (no standalone).
• Work with CCIIO and stakeholder partners to assess other federally-permissible options for offering stand-alone and/or supplemental vision benefits beginning in 2015 or as soon thereafter as possible.
Dental Benefits
• Federal guidance clarifies that supplemental adult dental benefits can be offered through Exchanges as long as coverage includes at least EHB-required pediatric dental benefits. Adult-only dental plans cannot be sold through Covered California.
• Pediatric dental benefits can be offered through standalone dental plans as well as a part of comprehensive qualified health plans.

2) CalHEERS – the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is the single, streamlined application that will serve both the Exchange and Medi-Cal.  The basic functionalities of this system are scheduled to be operational by October 2013.  During the Board meeting, it was announced that the build-out of CalHEERS has fallen one week behind schedule.


3) The Qualified Health Plan Model Contract – Approval of the QHP Model Contract was deferred to a special emergency Board meeting which will take place May 7, 2013.  A fifth revision of the contract was released, which includes some changes sought by CPCA.  To see CPCA’s comments on the QHP contract, please click here.

To see CPCA's comments on prior versions of the QHP Model Contract, see below:

Comments on the second version

Comments on the fourth version


4) Eligibility and Enrollment and the Assisters Program – New regulations have been released regarding both the Application, Eligibility, and Enrollment process for the Individual Exchange and In-Person Assisters.  CPCA will be providing comment on these regulations by the deadline.   Please click here to see the draft regulations on Application, Eligibility, and Enrollment process and click here for In-Person Assisters.

Please contact Meaghan McCamman at mmccamman@cpca.org if you have any questions.

Please click here for past advocacy and update announcements.

 

RESOURCES

 

 

CPCA CONTACT

If you have any questions about Covered California, or implementation of the Affordable Care Act, please contact Meaghan McCammon at (916) 440-8170 or mmcamman@cpca.org

 


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