Covered California Participants May Switch Plans

Recent investigations by the California Department of Managed Health went underway for Anthem Blue Cross and Blue Shield of California due to policy holders complaining they were given misleading information by the insurance giants. Policy holders argue that they were given inaccurate information regarding their benefit plans and provider networks. Anthem and Blue Shield are now facing multiple law suits from frustrated consumers.

So what is California doing about this? California is “quietly” taking a stand by educating consumer’s about a provision under the Affordable Care Act that acts in their favor. The ACA states that a person can receive health coverage during an open enrollment period or after a “qualifying life event”. A qualifying life event is usually considered when a person moves, gets married or divorced.

Under the ACA provision, the qualifying life event also includes when a person experiences misconduct by an insurer or receives misleading or inaccurate plan information from an insurer. Therefore, the provision under the ACA may enable these policy holders to switch health plans outside of the enrollment period because it is considered a “qualifying life event” since they were given misleading information from insurers.

California has slowly been implementing this provision for the past few months as complaints about Anthem Blue Cross and Blue Shield of California continue to rise. Still, Dana Howard, a Covered California Spokesperson has mentioned that every complaint will be considered but not every complaint will result in the ability to switch plans. According to Howard, there is not complete information on the number of switches thus far but confirms that the exchange has not been overwhelmed with requests to switch plans.

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