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Individuals & Families FAQ
What do you mean when you say you will "be my broker?"
As your broker, we become your advocate and helper for all concerns regarding your health insurance policy. Being your official broker means we have your permission to discuss your policy with your health insurance company and we can resolve problems or make changes on your behalf. It is our job to serve as your go-to contact when you have issues with claims, informing your health insurance carrier of an address change, adding a dependent to your plan, etc.
If I enroll in a plan, am I locked in to it for a certain amount of time?
No, you are not required to remain on the plan you decide to enroll in for a certain amount of time. You can terminate coverage at any time. However, if you terminate outside of the “open enrollment” period, you cannot enroll in a new plan until the next “open enrollment” period.
What do I need to do if I am interested in getting financial assistance through Covered California?
Let us know! We have the income guidelines for Covered California and are able to tell you if you qualify for a subsidy based on your income. There are different income levels depending on how many people will be enrolling per application so this is something you would need to ask us about so we could give you accurate answers. Covered California requires certain documentation as well to verify your information such as a copy of your driver license/ID, citizenship verification (if applicable), and proof of income (this can be shown using your tax forms for the current year). We are able to make this process easier for you and enroll you through our agency’s Covered California account so you don’t have to deal with completing the application on your own.
What is the "open enrollment" period?
For individuals and families enrolling in plans on their own (or changing their current plan) and not with their employer, that open enrollment period takes place during November 1st and January 31st. See the following dates for more specific information:
Nov. 1st – Dec. 15th for an effective date of January 1st
Dec. 16th – Jan. 15th for an effective date of February 1st
Jan. 16th – Jan. 30th for an effective date of March 1st.
After January 31st, there will not be an opportunity to enroll in a health plan until the following year’s open enrollment period, unless you have a “qualifying event” which you can read more about in the next question.
What is a qualifying event/Special Enrollment Period (SEP)?
A qualifying event is a life event that happens and qualifies you to enroll in health insurance outside of the open enrollment period, which is considered a “Special Enrollment Period.” These events can be things like losing insurance from your employer or your spouse’s employer, getting married, having a baby, turning 26 years old and no longer able to stay on your parent’s plan, moving to California from another state, becoming a citizen.
If you experience a qualifying event, you have 60 days to take action and enroll in a health plan. If not, you will have to wait until the next open enrollment period.
Visit the following link for more info on the Covered California site:
After I enroll, how long until I can start using my plan and see a doctor?
You can start using your plan on the date your coverage becomes effective. If you enroll for an effective date of February 1st, then you can use your plan starting on that date. Depending on when your application was submitted and how long insurance carriers take to process applications (during open enrollment it usually takes longer than the rest of the year), you may not receive your welcome packet and ID cards until after your effective date to start coverage but you would still be able to see a doctor if that’s the case. There are ways of getting temporary ID cards until you receive your hard copy and we can help you get those as well.
Small Groups FAQ
What kind of benefits will we have with you as our group's broker?
As your group’s broker, you will have our direct lines and emails to contact us with any questions and concerns regarding your group’s policy. We will be easily accessible to you and your employees as questions arise or issues need to be addressed. Once you enroll in a group plan through our agency, we will be who you contact when you have to change information for your company such as contact information, address updates, etc. We are also who you send employee information change forms, new hire applications, and other necessary forms so we can ensure they get to the right department of your insurance carrier. We will provide you with all of the forms you need from your carrier as well so you are aware of what is needed when changes need to be made. We will also be responsible for discussing your renewal with you every year thereafter and make sure you know your options to stay within your budget by creating spreadsheets and proposals with our broker tools. As your broker, we dedicate our time to serving your company’s health insurance needs so you don’t have to.
Are we locked into our group plan for a certain amount of time once we enroll?
No, you are not required to remain on the plan you decide to enroll your group in for a certain amount of time once you sign up. You can terminate coverage at any time.
When is it possible to make changes to our group plan after we've already signed up?
Every year you will have an “open enrollment” period and that is when you can make any changes to the plans you offer your employees and also enroll any employees who have not enrolled and would like to enroll in a plan. The open enrollment period is during the month your original coverage became effective. For example, if you enroll in group insurance effective September 1st, every year thereafter your “renewal date” or “open enrollment” period begins September 1st so you will have the entire month of September to make changes.
If you are completely unsatisfied with the group policy you’ve chosen and would like to switch plans before your open enrollment period, we can help you with that. However, you will have to switch insurance carriers entirely as you are not able to choose new group plans with the same insurance carrier unless it is your open enrollment period
Does it take long to get a group plan set up?
The longest part of this process is usually deciding on a plan. With so many options available, employers like to weigh their options and consider what would be best for both the employees and the company’s budget. We are able to produce quotes quickly and can usually send you a proposal to review the same day you send us a group census form. However, we would prefer to meet with you in person to discuss the proposal. There are many parts to consider and it would be easier for us to explain what certain things mean in person and ensure we are on the same page with the kinds of plans you’re interested in. Once a decision is made on the plan(s) you would like to offer and all paperwork is completed by the employer and employees, we send it to the carrier and it usually takes about 7-10 business days for the group to get completely installed.
Once the group plan is set up and everyone is enrolled, when can my employees begin using their plan?
They can begin using their plan on the day you have decided to be the effective date. If you decide on an October 1st effective date, employees are able to see a doctor that same day.
When will my employees get their ID cards?
Once the group plan is completely installed and the health insurance carrier has processed all applications, ID cards are sent to the home addresses of all members enrolling in a plan. Those cards take about 7-10 business days to reach members. If necessary, we can re-order ID cards at any time throughout the year. Just let us know which employee needs it and we will request new cards to be sent to them.