Covered California June Board Meeting

June 20, 2014

Yesterday was our favorite day of the month – the Covered California Board meeting (not joking – we’re very nerdy). There was plenty to discuss this month in preparation for the upcoming open enrollment. Here are the highlights.

2015 Plan Year

  • Contra Costa Health Plan will not be participating in Covered California in 2015. The 1,200 individuals currently enrolled in Contra Costa plans will have to select other plans upon open enrollment.
  • Provider networks, regional offerings, and plan structures/design cannot be significantly changed, although networks can be expanded
  • All carriers bid a 10.0 embedded dental offering for pediatric and family plans
  • Rate negotiation will occur in July, rates will be released in August, and finalized by October
  • Recertification of enrollment counselors will be completed by October 1
  • The plans will send renewal notices to members by November 1

Screenshot 2014-06-19 10.57.54


  • 1,519 groups have been enrolled, totaling 10,704 employees and dependents
  • SHOP is transitioning to a new administrative platform managed by a contractor. Only one third of groups who enrolled under the original platform have been transitioned to the new platform, but this process should be completed by the end of August.
  • Beginning in October, employers will be allowed to select a pair (either Platinum & Gold, Gold & Silver, or Silver & Bronze) of tiers to offer for employee choice of plan
  • In 2015, insurers can offer alternative benefit designs
  • The family dental embedded and supplemental plans will be offered in 2015, identical to the individual Exchange.

Web-Based Entities

  • Covered California is exploring how to work with online retail insurance sales entities so that they can enroll individuals in Covered California and Medi-Cal
  • There is disagreement about if web-based entities should use the Covered California design or if the entities can use their own interfaces applying Covered California policies
  • More analysis is needed before next steps can be pursued

Verification of Special Enrollment

  • Self attestation of life events that prompt special enrollment periods will continue, until the 2015 plan year, as Covered California does not have the capacity to create a verification process
  • Verification will be implemented next year, and may include a 30 to 90 pended eligibility period, conditional upon verification


  • The 2014-15 Budget was adopted, focusing on building sustainability for the Exchange

Screenshot 2014-06-19 15.49.05

Insurance Rate Public Justification Act

  • A proposition will be on the ballot in November that could greatly alter Covered California’s active purchaser role. It proposes making all insurance rates subject to prior approval by two regulators
  • Covered California staff and a sub-committee of the Board is analyzing the impact of the initiative on the Exchange
  • There are very serious concerns about the implications of the Proposition. The Exchange is an active and selective negotiator of premiums; are these negotiated rates going to be then subject to second round of state rate regulatory review, what happens if the rates are not approved on time or at all, how would retroactive review of rates from 2012 to 2014 work, and what if the current or future Commissioner disagrees with the decisions of the Board?
  • The Exchange is accepting input on their analysis – send comments to by June 27

Enrollment Assistance

  • The Board adopted a measure to merge the in-person assistance and outreach and education programs into an integrated Navigator program, which will become the platform for education, outreach, and enrollment assistance, with $16.9 million available in grants in 2015.
  • Grants will be based on the number of consumers Navigators expect to enroll in Covered California; it is performance based lined to how many subscribers pay their first premium
  • Outreach and Education grantees can continue under their existing grants and current Certified Enrollment Entities can continue under the $58/enrollment system through 2015 open enrollment
  • The CEC program will continue after 2015 but will become uncompensated
  • The grant proposals must be at least $50,000, with bonuses available for exceeding enrollment goals. 25% of the grant will be paid to the Navigators before open enrollment in October, with the remaining balance paid in installments of 25%
  • Navigators seeking hard to reach populations can justify applying for increased funding per enrollment
  • 10% of grant funds can be spent on media and Navigators are encouraged to set up storefronts
  • The goal of the Navigator program is to enroll 130,700 new consumers in Covered California
  • The application will be released next week, with applications due July 25, and the grants starting October 1

The meeting materials are available here. There won’t be a Board meeting in July, but check back in August for more important information.