Covered California December Board Meeting

December 16, 2014

This month’s Covered California board meeting was quick and simple, focusing on open enrollment, upcoming changes to the board, and changes to the plan contracts and standardized benefit design.

Board Changes
Bob Ross of the California Endowment announced that he is resigning from the board, effective December 31. He was nominated by former Senate pro Tem Darrell Steinberg, and now wants to allow new pro Tem Kevin de Leon to appoint a new member. Dr. Ross was very thankful for the support and work of everyone involved in Covered California’s launch. Additionally, members Susan Kennedy and Kim Belshe’s terms are set to expire at the end of the month, however they will stay on until the Governor nominates replacements.

Open Enrollment

One month into open enrollment, much has been going smoothly. Nearly 100,000 individuals have selected plans and many more have submitted applications. While December 15 was the enrollment deadline for January 1 coverage, this has been extended to December 21.

enrollment 12.14

So far, most enrollments (77%) have occurred with assistance from agents, CECs, and the call center. CECs and agents have reported easier processes this year with fewer obstacles. Some individuals, particularly young adults and mixed families, are experiencing issues with the new identity proofing process that verifies the identity of applicants through credit checks. More than 50% of enrollees have paid their first premium online immediately upon enrollment.

One of the biggest challenges to the renewal process has to do with individuals who were in Covered California plans in 2014, but are found “likely eligible” for Medi-Cal for 2015. These individuals are supposed to seamlessly transition to Medi-Cal with no gaps in coverage, however this has been difficult to implement, given that counties process Medi-Cal applications on different timelines than Covered California. Individuals in this situation can continue their Covered California coverage at full cost with no premium assistance while they wait for full approval from counties, or they can choose to cancel the Covered California plan, and Medi-Cal will be retroactive upon approval. There was some debate about Covered California’s ability to continue offering premium subsidies during the transition (until full-scope Medi-Cal is approved). Covered California is actively working with DHCS and the federal government to protect consumers as much as the law allows.

QHP Certification and Recertification
The board reviewed staff proposals for Qualified Health Plan (QHP) certification and new entrants policy. Under the proposal, which will be voted on next month, Covered California would allow insurance carriers that do not currently participate in the Exchange to offer coverage in 2016 only in counties that have limited competition and consumer choice (fewer than three current carrier options – totaling about 10% of consumers). UnitedHealthcare in particular expressed interest in offering plans through Covered California.

Alternative benefit designs will not be permitted in individual market but will be considered for SHOP. Regardless if the proposal is adopted, altered, or rejected, the Exchange will encourage current plans to expand into other regions and will allow Medi-Cal managed care plans and new entrants to participate for 2016.

Standardized Benefit Design

The board also discussed proposed changes to the standardized benefit design for 2016. The primary changes proposed are in the Bronze tier, aiming to lessen barriers to outpatient, routine care. Bronze would function more like a catastrophic plan in that the deductible would equal the out-of-pocket maximum ($6,500), however labs and outpatient rehab/occupational/speech therapy would be exempt from the deductible, and specialists would be added to the categories of providers (currently primary, urgent, and outpatient mental health care) for which consumers can use three visits without meeting the deductible.


Silver plans would be simplified and focus more on copays rather than coinsurance. The staff is also developing recommendations on specialty drug pricing regulations and tweaks to complying with mental health parity law. Stay tuned as those develop.


Meeting materials are available on the HBEX website here. Month one down, two more to go. Happy holidays, and we’ll check back in January with the latest news from Covered California.