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October Covered California Board Meeting

Covered California’s recent October board meeting was packed with information and insights about the work prefacing open enrollment three, which begins November 1, 2015. Updates on small business rates, rating of the quality health plans, enrollment strategies and the responsibilities of certified insurance agents were discussed.

Updates on Covered California for Small Business

Covered California is moving forward with two significant ACA regulations for small businesses: 1) starting in 2016, there will be a definition change of what constitutes a small business, increasing the employee number from 50 to 100, and 2) health coverage offered to employees by small businesses must be in compliance with ACA requirements. Due to these upcoming changes in the small business world, Covered California expects a lot of activity on the small business sector of the exchange. A marketing campaign targeting small businesses has already begun running and will continue through January 2016.

Similar to Covered California’s individual market, small business coverage offered on the exchange will also experience a rate increase. The increase is 7.9% statewide. The rates for small businesses are similar on and off the exchange.

The number of enrollments in Covered California for Small Business has increased since last month; through August 2015, the number of members is 19,465 up from 18,500 in July. The number of members makes up 2,865 small business groups.

Open Enrollment Marketing Update

Some of the key messaging during open enrollment three will focus on cost and price messaging and continued emphasis on the Covered California brand. Messaging focused on options for dental coverage offered by the exchange, as well as individuals’ need for balance between prevention and emergency care offered by health coverage are all motivating factors for consumers. The messaging campaign strategy for open enrollment three is grounded in research from the previous two open enrollments. Specifics of Covered California’s paid media marketing for the upcoming open enrollment is below.


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Renewals will again be automatic if consumers are passive and make no actions to change their plan. However, Covered California will encourage consumers to research available options and shop around. The renewal message will also emphasize to individuals that coverage is important to have for unforeseen events that may happen in the future, and not that coverage is something a consumer should be getting their monies-worth from, which could lead to disenrollment.

Auto-renewals will begin November 13, 2015.

Non-Tax Filer Approach

Starting this year, Covered California must adhere to federal regulations stating consumers that received tax credits in 2014, but did not file taxes will not be eligible for tax credits in 2016. Although Covered California states this number is not too high (the exact number was not provided), there are some individuals in this situation. Starting in November, Covered California will notify these individuals. Individuals can still buy a plan on the exchange, but tax credits for the coverage sought will be removed.

Health Plan Quality Reporting – Open Enrollment 2016

The ratings for the Qualified Health Plans (QHP) on the exchange have now been released. QHPs received between one and four stars. Molina Healthcare was the only QHP to receive one star, while Kaiser Health Plan Inc., North and South; Sharp Health Plan, offered in San Diego; and Western Health Advantage, offered in the North Bay and Sacramento, received four star ratings. Plans and rating are presented below, with the exception of the plans being introduced only this year.
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All of the health care plans are working with Covered California on how to improve consumer experiences with their plan. The lower scoring plans have begun to put together action plans to improve their scores. As discussed at the last meeting, the ratings are based only on consumer satisfaction surveys and do not include clinical measurements of how the plans are faring. Covered California has stressed that although consumer experience is a key piece of information for consumers to take into account, clinical measures and actual health care quality must also be considered. HEDIS report cards, although not available specifically for the QHP plans, are one source of clinical ratings that consumers may want to refer to when making their plan decisions.

The global rating questions reflect the level of satisfaction from a very small sample of consumers (1,000, with only a 21% response rate) with their QHP coverage during the first year of coverage.

The rating system is an integral part of the original intent of the exchange, which is to provide more transparency on price and quality of plans so consumers can make the most informed decisions. Covered California will continue to work with Centers for Medicare and Medicaid Services to improve the sample size and other factors that limit the survey’s content and value.

Covered California Data Picture – Active Membership

Covered California has released a treasure trove of data on their members that have been enrolled and paid their premiums (i.e. active membership). The data is broken up by a number of factors including, issuer, tier, premiums, gender, age, health plan, region and many more. This information has been instrumental in tailoring the messaging campaign for open enrollment three to enroll harder to reach populations.

Some of the highlights from the data are:

  • 1.3 million individuals are currently enrolled.
  • Of those individuals that left Covered California coverage, 85% have coverage from another source (employer-based, Medi-Cal, private, and other).
  • 90% of consumers with active membership received federal subsidies to help pay premiums, with on average about 70% of the cost being covered by the subsidy.
  • Certified insurance agents enrolled the highest number of consumers (41%). There are still many individuals (28%) that enroll without assistance.
  • In comparison to CalSIM projections, Covered California membership by Black or African American consumers and those aged 19-29 are lower than the estimates for these populations.

Active membership data will be updated every three months. The complete data presentation from Covered California can be found here, with the data sheets found here.


Since the last meeting Covered California has decided that no action is required in regards to the responsibilities of certified insurance agents. As was discussed in the August Board meeting, certified insurance agents currently assist individuals apply for Medi-Cal or CHIP. This process was flagged as an issue for discussion as some stakeholders felt that it might be in the consumers’ best interest to be assisted by county eligibility worker due to eligibility workers’ comprehensive knowledge of the Medi-Cal program. However, after much input from a stakeholder meeting on the subject, Covered California will keep the current practice in place (i.e. insurance agents will continue to assist Medi-Cal eligible enrollees), with no action by the Board required.

Insurance agents have expressed their need for more training and toolkits to better understand the Medi-Cal program so they are fully confident in relaying this information to their clients. Covered California has heard this request and will work with stakeholders to meet this need. Additionally, Covered California encouraged insurance agents to use their best judgment in referring consumers to eligibility workers in emergency situations when Medi-Cal processing may be expedited. The no-wrong-door approach kept in place has the best chance of ensuring everyone is assisted when they present for help in enrolling in coverage.

Next Meeting Action Item

During the Covered California board meeting in November, decisions on changes to the appeals process will be taken.

Covered California Board Calendar

The next meeting will be held Thursday, November 19, 2015. A proposed calendar for 2016 was released at the meeting.
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All materials from the meeting as well as the broadcast of the meeting can be found here.