It is acceptable to submit the declarations page from the agency’s policy as evidence of the agent’s coverage, provided that the agency’s policy does actually cover the agent.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

There will be a field in the application to designate the agent.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

Out-of-pocket costs are the consumers’ expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, co-insurance and co-payments for covered services plus all costs for services that aren’t covered.

The out-of-pocket maximum is the most consumers pay during a policy period (usually one year) before their health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing, or spending for non-essential health benefits.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

Household income is the sum of a taxpayer’s modified adjusted gross income (MAGI) plus the aggregate MAGI of all the individuals for whom a taxpayer properly claims a deduction for personal exemption and are required to file a tax return. Hence, if the taxpayer does not claim a deduction for personal exemption for another individual, only the taxpayer’s income will be considered for eligibility for premium assistance.
See example on page 15 in the Eligibility for Individuals and Families participant guide.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

A number of agents have reported that they can’t access their agent portal. Many of them, it turns out, created two accounts for some reason. There can only be one “certified” account per agent/license #. These agents have been trying to access their clients through a non-certified account. Here’s what to do to check if this is the problem that’s impacting you:

Determine if the account is “certified” by looking at the Certification Status screen. See the screenshot in the link here:
https://www.claremontcompanies.com/wp-content/uploads/2014/01/CoveredCA-Agent-Certification-Status-Screenshot.png

If Certification Status indicates “Certified,” then that’s the account you should use and to avoid confusion you should call the service center (1-877-453-9198) and have the other account deleted.

If Certification Status indicates “Eligible”, as in the screen shot, then that account is not valid, but you shouldn’t delete this “Eligible” account until you have confirmed you have a “certified” account.

If you don’t know the username and password for an account, you will need to call the service center to get the username and get a password reset.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

See below a link to a Covered California Medicare FAQ:
https://www.coveredca.com/FAQs/FAQ-PDFs/FAQ_Medicare.pdf

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

Two-consecutive taxable years beginning in 2014 or later, for which the eligible small employer files an income tax return with an attached Form 8941. If the small business took the tax credit in the 2013 tax year or earlier, that does not count as part of the two-consecutive tax years.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

In order to be eligible for the Covered California for Small Business, an employer must be a “small employer” as defined in state law.  (10 CCR 6522(a)(1)). A “small employer” is defined as an any person, firm, partnership that … employed at least one , but no more than 100 eligible employees, … and in which a bona fide employer-employee relationship exists. (See Health and Safety Code 1357.500(k) and Insurance Code 10753.14). With a group of one, or a group of several, but all are owners or partner, a bona fide employer-employee relationship does not exist.

Likewise, federal rules preclude this type of group from qualifying as a “small employer” eligible to participate in the Covered California for Small Business. Section 1304 of the Affordable Care Act defines “small employer” as an employer who employed “at least 1 employee on the first day of the plan year,” but no more than 100 employees on average in the preceding calendar year. (ACA § 1304(b)(1)( 2); 42 U.S.C. § 18024(b)(1)(2)). In the preamble to the final rules on this issue, the federal government explains that the regulations and the ACA have based the definitions of “employer,” “employee,” and “small employer” on long-standing definitions in section 2791 of the Public Health Service Act (PHS Act).  (77 Fed. Reg. 18399 (March 27, 2012)). Specifically, the definition of “employee” in the PHS Act is incorporated by reference to section 3(6) of the Employee Retirement Income Security Act (ERISA), which defines the term employee the same as it is defined under common law to mean “any individual employed by an employer.” (29 U.S.C. § 1002(6); See also Nationwide Mutual Insurance Co. v. Darden, 503 U.S. 318 (1992) (holding that the term “employee” as used in ERISA refers to common law principles)). Thus, to be eligible for Covered California for Small Business “the employer must employ at least one common law employee.” (77 Fed. Reg. 18399 (March 27, 2012)).

Therefore, under both state and federal law, a group must employ at least one employee and must have some sort of employer-employee relationship. In the case where there is only one individual, or several individuals who are owners or partners, irrespective of whether any of them is issued a W-2, an employer-employee relationship does not exist and is therefore not eligible for Covered California for Small Business coverage.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)

Within 5-7 days of submitting the signed agent agreement and associated documentation (assumes correctly completed) and paying the endorsement fee, the next steps occur:

1. Your status on CoveredCA.com will be updated to “Certified.” And you’ll receive an email confirming your status change.
2. Your name and contact information is added to the Covered California website.
3. Consumers and small businesses will be able to find your details by clicking “Find an Agent” on this page.
4. You’ll be able to update and edit your Covered California public facing profile.
5. Covered California will update the California Department of Insurance (CDI) website with your endorsement information. This fulfills a requirement by CDI and provides another place where consumers can verify that you’re certified.

More information on the Certification process can be found here.

There may be a more recent answer to this question. Contact Claremont for an update.
(View Full Answer)