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Special Enrollment Period
Consumers have how many days from the date on which the qualifying life event happens to enroll in a CovCA plan?
60
What document shows the amount the IRS paid to a consumers insurance company to lower the cost of health coverage?
Form 1095-A
Failure to pay COBRA premium is considered loss of coverage and a consumer meets a QLE to enroll during Special Enrollment Period.
No/False. If a consumer stops paying their COBRA premium and loses coverage, they will not be eligible for a SEP through CovCA and will only qualify for a special enrollment, if:
1. Someone else is responsible for sending the payment, 2. The individual moves out of the plan coverage area, 3. The individual reaches the plan's lifetime limit for benefits.
Name three QLE examples?
•Lost or will soon lose health insurance coverage (including Medi-Cal)
•Permanently moved to/ within California
•Had a baby or adopted a child, or became a foster parent to a child
•Got married or entered to a domestic partnership
•Returned from active-duty military service
•Gained citizenship/ lawful presence
•Member of a Federally-recognized American Indian or Alaska Native tribe
•Other qualifying life event*
To be eligible for enrollment into a CovCA plan during the Special Enrollment Period, a consumer must experience what?
Qualifying Life Event
A consumer must be previously or currently enrolled in a CovCA plan to qualify for SEP?
False
What form will CovCA members who enrolled in a minimum coverage plan receive from their insurance company?
Form 1095-B or 1095-C
Where in the CalHEERS account, can a consumer access their IRS Form 1095-A?
Home Page or under
Documents & Correspondence
A consumer currently enrolled in coverage and aware of the date their coverage will end, along with the regular SEP period can also proactively do what to avoid a lapse in coverage?
Can enroll with CovCA one month in advance.
What does QLE stand for?
Qualifying Life Event
Why does moving between statuses (e.g. from LPR/green card to citizenship) not qualify as a QLE
An individual who is a citizen, a national or lawfully present meets the requirements for CovCA enrollment.
How long are CovCA Enrollment Entities required to keep the "Authorization for Enrollment Assistance form?
aka the Consent Form
10 years
What does MEC stand for?
Minimum Essential Coverage
If the SEP enrollment window is missed, when will consumers be able to enroll in a health plan?
The next annual Open Enrollment Period.
Are California residents required to maintain minimum essential coverage, and what may it mean for those who don't?
Yes, the Californian individual mandate generally requires that all CA residents maintain MEC for each month of the year. Those who do not meet this requirement must pay a penalty on the state income tax return unless they qualify for an exemption.
Name at least two examples of Minimum Essential Coverage (MEC)
Employer-sponsored insurance
Individual market coverage purchased through CovCA or directly from issures
Medicare Part A & C
Medi-Cal coverage
No - the final rule applies only to individuals who already have an approved DACA status.
For 2025, employer-sponsored coverage is considered affordable if the employee's share of the premium for the lowest-cost plan to cover the employee only (not including the family) is not more than what percentage of the employee's household income?
9.02%
What new Qualifying Life Event did CovCA recently announce allowing qualified consumers to enroll through a SEP from February 1 until December 31, 2025?
DACA recipient