COA Fact Sheets
What doctors of optometry need to know about the ACA
This fact sheet highlights what the Patient Protection and Affordable Care Act (ACA)
requires of doctors of optometry as individuals and small employers, i.e., those with 50
or fewer employees relative to health care insurance.
Who is mandated to have health insurance?
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Beginning January 1, 2014, virtually all individuals are required to have health
insurance that meets minimum essential coverage (see “Mandated coverage,” below).
There is no requirement for employers to provide health care coverage to their
employees. However, certain financial incentives exist for some employers who choose
to provide health insurance through California’s Exchange, called “Covered California”
(see “Covered California,” below).
Beginning January 1, 2015, employers of more than 50 full-time equivalent
employees (FTEs) that do not offer affordable health insurance that provides minimum
value to their FTEs (and dependents if covered) may be required to pay an assessment,
called an “Employer Shared Responsibility Payment,” if at least one of their full-time
employees is certified to receive a premium tax credit through the Covered California
insurance marketplace. A full-time employee is defined as one who is employed an
average of at least 30 hours per week (see “Employers with 50 or More Employees”).
If your health insurance coverage is currently provided by your employer, meets
federal minimal coverage levels and is affordable, you do not need to change
anything. If you are covered by a plan that existed on March 23, 2010, your plan
may be "grandfathered" (see “Grandfathered plans,” below); however, you may
not get some rights and protections that other plans offer.
Mandated coverage
All health care policies offered through Covered California and those policies in the
private marketplace not grandfathered (See “Grandfathered plans,” below) must offer
the below 10 essential health benefits:
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5.
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including behavioral health
treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care.
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COA Fact Sheets
Pediatric vision benefits defined
Most health plans in the exchange will contract with a vision plan to provide the pediatric
vision essential benefit required under the law. The benefit includes an eye exam and
glasses for children up to 19 years of age. Low vision will also be covered.
Will adult eye exams be covered in Covered California plans?
No. Based on federal regulations released in February that prohibit adult eye exams to
be covered as essential benefits, the state Department of Managed Care and Covered
California have determined that qualified health plans (QHPs) in the exchange can’t
cover adult eye exams at all. Additionally, supplemental adult vision coverage is
currently not available under Covered California. Covered California is having problems
figuring out how to provide that coverage within federal guidelines. COA continues to
advocate that Covered California should ensure that adult coverage is made available in
a timely way.
In addition to the mandated essential health benefits, above, unless indicated otherwise,
all insurance policies must feature the following:
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Guarantee issue: Covered California, non-grandfathered, employer-sponsored
grandfathered, and government plans must sell coverage to everyone interested,
regardless of pre-existing conditions, and cannot charge more based on health status or
gender (see “Grandfathered plans,” below).
No lifetime and annual limits: All insurance plans are prohibited from imposing
financial lifetime limits on coverage of the 10 essential health benefits, and Covered
California, non-grandfathered, employer-sponsored grandfathered and government
plans may not place annual limits on these benefits (see “Grandfathered plans,” below).
Coverage cancellation prohibitions: No coverage may be cancelled by any plan
because of an honest mistake, left out information that has little bearing on one’s health
or the policyholder gets sick. However, a carrier may cancel coverage if a person’s
insurance application contains false or incomplete information on purpose and if
premiums are not paid on time.
Free preventive care: Covered California, non-grandfathered and government plans
must cover certain adult, women and children preventive services delivered by a network
provider without charging a copayment or coinsurance and without having met the yearly
deductible (see “Resources,” below, for links to those preventive services).
Grandfathered plans do not have to meet this requirement (see “Grandfathered plans,”
below).
Out-of-pocket expense limits: Limits annual co-pays, co-insurance, deductibles, etc.,
to $6,350 per individual and $12,700 per family.
Children’s coverage: All plans that cover children must allow them to be added or kept
on the health insurance policy until they turn 26 years old, even if they are married, not
living with their parents, attending school, not financially dependent on their parents, and
eligible to enroll in their (the child’s) employer’s plan.
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COA Fact Sheets
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Doctor choice and emergency room access: Covered California, non-grandfathered
and government plans must provide the opportunity to choose a doctor from your health
plan’s provider network, not require you to obtain a primary care doctor referral to see an
OB-GYN provider, and allow you to use an out-of-network emergency room without
penalty or prior approval (see “Grandfathered plans,” below).
Premiums: Health insurance premiums can only vary based upon location of insured,
family composition and age (three levels).
Individual mandate
With certain very limited exceptions, beginning in 2014, individuals must have and
maintain health insurance that provides for the minimum essential coverage (see
“Mandated coverage,” above) obtained through:
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The private insurance market (Note: COA members are encouraged to contact COAsponsored insurance broker Marsh for more information on their health care options.
Marsh insurance experts are certified by Covered California to sell individual and small
group insurance in the Covered California marketplace. In addition, they can discuss
alternative networks in the private marketplace that might have broader options and
coverages to meet member’s needs. Contact Marsh at 800-775-2020.)
An employer plan that meets affordability and minimum value requirements (see
Covered California,” below)
A state or federal health insurance Exchange; the Exchange in California is “Covered
California” (see “Covered California,” below)
A government program, e.g., Medicare, Medi-Cal, CHIP, TRICARE, etc.
Grandfathered plans Those health insurance policies that were in existence on March
23, 2010, and have stayed basically the same are considered “grandfathered” even if a
person joined the plan after that date. Grandfathered plans do not have to provide free
preventive care or protect the right to choose a doctor or access emergency care outside
the plan network. Additionally, grandfathered individual health insurance plans (the
kind you buy yourself, not the kind you get from an employer) can place annual
financial limits on covered benefits not part of the essential health benefits and do not
have to cover pre-existing conditions. Plans lose their grandfathered status when
changes are made to eliminate a diagnosis or condition treatment benefit, increase costsharing for the policyholder, increase the deductible or out-of-pocket maximum more
than 15 percent plus inflation, increase a co-pay by more than $5 plus inflation, decrease
the employer contribution by more than 5 percent, impose dollar value limits below
specified amounts, etc.
Fines (taxes)
Persons who do not obtain health insurance are subject to the below fines (taxes):
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In 2014, the fine is 1 percent of annual income or $95 per person for the year, whichever
is higher. The fine increases every year. In 2016 it is 2.5% of income or $695 per
person, whichever is higher.
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COA Fact Sheets
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In 2014, the fine for uninsured children is $47.50 per child up to $285.
It's important to remember that someone who pays the fine won't get any health insurance
coverage. They still will be responsible for 100 percent of the cost of their medical care.
Covered California
Beginning on October 1, 2103, individuals and small businesses have been able to
enroll in the newly created state health insurance exchange, Covered California.
Coverage for services will begin on January 1, 2014. Covered California is an online
marketplace where California residents and small businesses will be able to shop
online, over the phone or in person to find health care insurance options and compare
different health insurance plans. Individuals will learn if they qualify for federal financial
assistance (subsidies) or are eligible for public health programs like Medi-Cal.
Employers with fewer than 25 full-time workers will be able to find out if they qualify for a
small business tax credit that can help cover the cost of providing employee health care.
It is estimated that 2-5 million Californians will be newly enrolled in a health plan through
Covered California by 2017.
All plans available through Covered California meet state and federal requirements for
affordability and minimum essential coverage. It is the only place in which qualified
individuals and businesses can obtain federally authorized financial premium
assistance, cost-sharing assistance and tax credits to reduce their health care
costs.
Plan types
Individuals and small businesses have the choice of several health plan types within
Covered California:
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COA Fact Sheets
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Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations
(EPOs): Some of these plans may limit coverage to providers inside their networks. If a
policyholder uses a doctor or facility that isn't in the HMO’s network, he or she may have
to pay the full cost of the services provided. HMO members usually have a primary care
doctor and must get referrals to see specialists. This is generally not true for EPOs.
Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS): These
insurance plans give a choice of getting care within or outside of a provider network.
With PPO or POS plans, a policyholder may use out-of-network providers and facilities,
but will have to pay more than using in-network ones.
High Deductible Health Plan (HDHP): These plans typically feature lower premiums
and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans
with a minimum deductible of $1,250 per year for individual coverage and $2,500 for
family coverage. With an HDHP, the policyholder can use a health savings account or
a health reimbursement arrangement to pay for qualified out-of-pocket medical
costs. This can lower the amount of federal tax owed.
Catastrophic Health Insurance Plan: Available only to people under 30 and to some
low-income people who are exempt from paying the fee because other insurance is
considered unaffordable or because they have received "hardship exemptions," these
plans cover essential health benefits at a generally lower premium than traditional
coverage but have a very high deductible. Generally, this means they provide "safety
net" coverage in case of an accident or serious illness. Catastrophic plans usually do not
provide coverage for services like prescription drugs or shots. Covered California-offered
catastrophic plans cover three annual primary care visits and preventive services at no
cost. After the deductible is met, they cover the mandated essential health benefits.
People with catastrophic plans are not eligible for lower costs on their monthly premiums
or out-of-pocket costs.
Medi-Cal: Working in partnership with the state Department of Health Care Services,
eligible individuals can obtain Medi-Cal coverage through Covered California.
Plan categories
The plans in Covered California are offered in four categories. Called "The Medal Plans," these
plans pay a designated percentage of health care costs, including deductibles, co-pays, coinsurance, etc., and premiums will differ based on the plan selection. Those plans are:
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Platinum: Plan pays 90 percent of the costs, policyholder pays 10 percent
Gold: Plan pays 80 percent of the costs, policyholder pays 20 percent
Silver: Plan pays 70 percent of the costs, policyholder pays 30 percent
Bronze: Plan pays 60 percent of the costs, policyholder pays 40 percent
Coverage for individuals
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COA Fact Sheets
Individuals can apply for coverage anytime during the initial open enrollment period beginning
October 1, 2013, through the end of March 31, 2014. After open enrollment ends on March 31,
2014, health coverage through Covered California is not available until the next annual
enrollment period (October 2014-December 2014) unless there is a qualifying life event, for
example, move to a new state, certain changes in income, or change in family size from
marriage, divorce or a baby.
Covered California has established 11 health plans in 19 pricing regions throughout the
state from which individuals can purchase health care insurance. Those plans are:
1. Anthem Blue Cross of California
2. Blue Shield of California
3. Chinese Community Health Plan
4. Contra Costa Health Plan
5. Health Net
6. Kaiser Permanente
7. L.A. Care Health Plan
8. Molina Healthcare
9. Sharp Health Plan
10. Valley Health Plan
11. Western Health Advantage.
Each region has an average of four insurers. The pricing regions consist of individual
counties or a regional group of counties. To find what plans are in your county, click
here and scroll down to page 11.
How can doctors of optometry participate as a provider in Covered California?
Doctors of optometry will not necessarily “sign up” to participate in the exchange. In fact,
Covered California is not responsible for contracting with any type of providers. Instead,
providers will be able to participate in the exchange through contractual relationships
with the QHPs that have been selected. Doctors of optometry should contact all of the
plans chosen to participate in their county to determine how they will cover the pediatric
vision essential benefit. The plan should be able to inform you whether they are
contracting directly with doctors of optometry, and how you can sign up to become a
provider on their panel, or whether they have contracted with a vision plan for the
coverage. If they have contracted with a vision plan, you should then contact that vision
plan to become a network provider if you currently are not a participating provider in the
plan. Once you are contracted with the QHP or the vision plan, you will then be able to
see individuals in the exchange receiving coverage by those plans in your region.
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COA Fact Sheets
Premium and cost-sharing assistance
Individuals who purchase insurance through Covered California and are not currently receiving
affordable health insurance through an employer or public program that meets minimum
coverage requirements, are eligible for subsidies for health insurance premiums and costsharing if their income meets certain eligibility requirements. Those subsidies include:
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Premium assistance: Premium assistance is available from the federal government to
help lower the cost of health coverage for individuals and families who make less than
400 percent of the federal poverty level (FPL) – up to $45,960 for individuals and
$94,200 for a family of four. If purchasing coverage through Covered California, premium
assistance can be immediately applied which reduces the amount paid by the
policyholder each month (see Covered California “Shop and Compare Tool”).
Cost-sharing subsidies: These subsidies, available with Silver plans only (see “Plan
categories,” above), reduce the out-of-pocket amount of health care expenses an
individual or family has to pay. These expenses might include copayments for health
care services or other costs you pay when you get services. Those with incomes that are
less than about $28,725 for a single person and less than about $58,875 for a family of
four in 2013 may be eligible for those subsidies.
Medi-Cal assistance: Starting in 2014, Medi-Cal will expand to cover people under age
65, including people with disabilities, with income of less than $15,856 for an individual
and $32,499 for a family of four. The coverage is free for those who qualify.
An online calculator at the Covered California website helps estimate how much it will cost to
purchase health insurance in 2014 and the amount of financial assistance available to qualified
individuals. In addition, by completing a Covered California application, an individual will learn
whether he or she qualifies for free coverage through Medi-Cal.
Marsh or Covered California coverage application process
The purchasing process is easy and you can choose the method that works best for
you:
Marsh:
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COA Fact Sheets
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Call Marsh client services to explore all your options, both within Covered California and
in the private marketplace, at 800-775-2020
Online
Covered California
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Online.
Call the Covered California Customer Call Center at (888) 975-1142.
Covered California Certified Insurance Agents and Certified Enrollment Counselors are
available in your community to provide expert advice and support. Find one by calling
(888) 975-1142, or online.
Send application forms to:
Covered California Service Center
P.O. Box 3530
Rancho Cordova, CA 95670-5667
Small Business Coverage – 50 Employees or Less
Small businesses with 50 or fewer employees can also obtain health insurance for their
employees through Covered California’s Small Business Health Options Program
(SHOP). (Note: If self-employed with no employees, you can get coverage through
the individual market, but not through SHOP.) SHOP has six health plans similar to
those usually available only to larger employers in 19 pricing regions throughout the
state from which businesses can purchase health care insurance that feature the same
plan types and categories as individual plans. Those carriers are:
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Blue Shield of California
Chinese Community Health Plan
Health Net
Kaiser Permanente
Sharp Health Plan
Western Health Advantage
No region of the state has fewer than three health insurance plans available, and most
will have four or more, with dozens of products to choose from. The plans, a mix of
health maintenance organizations (HMOs) and preferred provider organizations (PPOs),
are be sold through licensed agents who are trained and certified by Covered California,
including COA-sponsored broker Marsh. All plans offered through SHOP must be
offered outside Covered California by the specified carriers at the same cost and
network. However, the premium assistance and employer tax credits are available only
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COA Fact Sheets
on plans purchased through SHOP. To find what plans are in your county, click here
and scroll down to page 10.
Whether purchased through Covered California or on the private insurance market,
small group plans must feature the following:
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Participation: Must offer coverage to all full-time employees – generally those working
30 or more hours per week on average.
Plan enrollment: Employers can enroll in SHOP or the private marketplace throughout
the year.
Premium assistance and cost-sharing: Employees are not eligible for premium
assistance and cost-sharing subsidies if the employer offers a health insurance plan that
pays at least 60 percent of the essential coverage and the employee contribution to the
plan for employee-only coverage is no greater than 9.5 percent of the employee’s
household income.
Deductibles: Limit deductibles to no more than $2,000 per individual and $4,000 per
family in a policy year. Note: Carriers can exceed these limits if their plans cannot
reasonably reach the coverage actuarial value the law sets.
Waiting periods: Coverage waiting periods for new FTEs cannot exceed 60 days.
Employer SHOP tax credits available only through Covered California
Available only to small employers who purchase health care insurance through SHOP, ACA
extends the small business Health Care Tax Credit to provide employers with a tax credit if the
business 1) has fewer than 25 FTEs for the tax year, 2) pays employees an average of less
than $50,000 per year and 3) contributes at least 50 percent toward employees’ premium cost
(35 percent for nonprofits). Employers with 10 or fewer full-time-equivalent employees with
wages averaging $25,000 or less are eligible for the maximum amount of tax credits. For
purposes of calculating employee count, the number of employees does not include business
owners or family members.
Advance payments of the tax credit can be used right away to lower monthly premium costs. If
qualified, an employer may choose how much advance credit payments to apply to premiums
each month, up to a maximum amount. If the amount of advance credit payments received for
the year is less than the tax credit due, the employer will get the difference as a refundable
credit when through the business’ federal income tax return. If the advance payments for the
year are more than the amount of the credit, the employer must repay the excess advance
payments with the tax return.
To calculate your FTEs and average annual wages for the purposes of this credit, refer to this
Q&A from IRS. Or, use this Small Business Health Care Credit Estimator to help find out
whether the business is eligible for the credit and how much might be received.
Get applications for coverage through SHOP below:
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For employers
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COA Fact Sheets
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For employees
Or you can sign up online at the Covered California website by clicking here.
Other employer obligations under ACA
All California employers must comply with the below regardless if health benefits are
provided to employees:
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Health Insurance Marketplace Coverage Options: Written notice is required to be
provided to all current employees describing the existence of, and options
available, under Covered California, as well as the employee’s potential eligibility
for tax credits. Additionally, this notice must be provided to new employees within 14
days of a new hire's start date. The federal Department of Labor has created two model
notification forms which are available to download in English and Spanish. One form is
for employers who do not offer coverage and one for employers who do offer coverage.
(Note: As of this writing, there are no penalties for not providing the notice, however, the
U.S. Department of Labor has announced it will establish penalties.) Below are links to
the model notification forms:
→ Model Notice for employers that offer a health plan to some or all employees
- MS Word Format - en español Printer Friendly Version - MS Word Format
→ Model Notice for employers that do not offer a health plan - MS Word Format
en español Printer Friendly Format - MS Word Format
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Additional Medicare withholding: Beginning January 1, 2013, ACA increases the
employee portion of the Medicare Part A Hospital Insurance (HI) withholdings by .9
percent (from 1.45% to 2.35%) on employees with incomes of over $200,000 for single
filers and $250,000 for married joint filers. It is the employer’s obligation to withhold this
additional tax, which applies only to wages in excess of these thresholds. The employer
portion of the tax remains unchanged at 1.45%.
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Limits on Flexible Spending Account contributions: For plan years beginning
on or after January 2013, the maximum amount an employee may elect to
contribute to health care flexible spending arrangements (FSAs), aka Section 125
plans or “cafeteria” plans, for any year is capped at $2,500, subject to cost-ofliving adjustments. The limit only applies to employee contributions and does not
extend to employer contributions. Learn more about FSA contributions, as well as
what is excluded from the cap, from this IRS-provided document.
Employer-provided health care coverage considerations
As stated above, ACA does not require employers to provide employees with health
care coverage. This is an employer choice. In considering whether to continue or newly
offer employees health insurance, you might take into account the following:
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COA Fact Sheets
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The offering of employer-provided health insurance can be helpful to attract and retain
quality workers.
Coverage can improve the health of workers; employees with health insurance could
result in reduced costly absenteeism and turnover, and make for happier and
productive workers.
People who are insured are protected against uncertain and high medical expenses
and are therefore more likely to receive needed, timely and appropriate health care
and thus reduce lost productivity due to work absences.
Employer involvement in the selection and provision of health care benefits creates a
work environment concerned about employee health and productivity, including
prevention and wellness.
Because most large employers provide employer-sponsored health insurance, small
business-provided health care coverage can assist in competing for talent and
provides a valued benefit to promote employee loyalty and morale.
Individuals strive to improve their own marketability through education, experience,
and skill development so they can work for the companies with the best compensation
and benefits.
An employer-provided health insurance plan can also be an attractive option because
of the favorable tax treatment for employees as premiums may be payroll deducted
before taxes.
Communicating to your employees
Whether an optometric practice decides to provide health care benefits to its
employees, most of the practice’s employees will nonetheless be required to obtain
health insurance. In promoting mutually beneficial employer-employee relations,
educating employees on the basics of their options may well be a worthwhile
investment. This also provides an opportunity for practice owners to educate and
engage their employees on the scope of the practice’s employee benefits.
Below are some thoughts for using health care reform as an opportunity to engage, educate and
empower your staff:
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Don’t overwhelm with too much content. As this fact sheet conveys, health care
reform is multifaceted. However, short summaries of information are much more
digestible and should focus on basics, e.g., requirement for coverage, options to
obtain coverage, premium assistance and cost-sharing availability (if applicable),
etc.
Build a strong foundation. Crafting a powerful message around the ACA as it
relates to your practice will outline for employees what information they actually
need to know.
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COA Fact Sheets
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Don’t leave it to government-driven communication. Your employees are likely
reading and hearing about health care reform from many sources. Mandated
communications dictated by the government may cause more confusion if the
practice does not carefully deliver a message that is tailored to your business.
Make sure your employees are not in the dark by providing supplementary
materials to mandated notices (there are a number of fact sheets on the Covered
California website that can be tailored to your practice).
Toss the textbooks. Don’t talk academically or politically about health care
reform. Instead, use your practice’s voice, language and tone, and communicate
in a style that your employees already know. Deliver high-level information on
how the law will affect them in a format that will work for their job and lifestyle.
Reach employees where they are. We live in a digital world where people are
plugged into smartphones, tablets and computers all day long. Communicate
with workers through the medium they are used to: information on a screen, with
a variety of action, and a narrative. Consider making information easily
accessible through an Internet or intranet connection, which works for people
whether they are tuning in at the office or home.
Communicating with your patients
We know you are getting lots of questions from patients. COA has developed a list of
the most common questions our doctors are getting and some quick answers you can
provide your patients.
Q: Will I qualify for help with my costs?
A: Starting in 2014, there will be several government programs that offer financial
assistance to reduce the cost of health insurance.
1. Premium assistance — Federal help will be available to reduce the cost of an
individual’s or family’s monthly health insurance payments. Individuals who make
up to $45,960 and families of four that make up to $94,200 may qualify for
premium assistance.
2. Cost-sharing assistance — Cost-sharing subsidies reduce the amount of health
care expenses an individual or family has to pay at the time of medical care.
Those with incomes that are less than about $28,725 for a single person and less
than about $58,875 for a family of four in 2013 may be eligible for those
subsidies.
3. Medi-Cal - Free or low-cost health coverage for those who qualify, including
people with disabilities, and those with incomes of less than $15,000 for a single
individual and $31,180 for a family of four.
This online calculator will help you estimate how much it will cost to purchase health
insurance in 2014 and the amount of financial assistance available.
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COA Fact Sheets
Q: What kind of coverage is available?
A: Covered California will offer many of the same health plans available on the private
market today.
 Individual consumers will have a choice of up to 12 health insurance
companies through Covered California, depending on location. Anthem Blue
Cross, Blue Shield and Kaiser are available in all counties.
 Businesses with 50 or fewer full-time equivalent employees (FTEs) will be
able to choose from six carriers through the Small Business Health Options
Program (SHOP). The plans, similar to those usually only available to larger
employers, will be available from Blue Shield of California, Chinese Community
Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan and Western
Health Advantage. Tax credits are available to eligible employers with 25 or
fewer FTEs.
Q: What is the eye care benefit under Covered California?
A: Most health plans in the exchange will contract with a vision plan to provide the
pediatric vision essential benefit required under the law. The benefit includes an eye
exam and glasses or contact lenses for children up to 19 years of age.
Unfortunately, there is no vision coverage for adults at this time.
Q: What is the penalty if I don’t get insurance?
A: In 2014, people who can afford to but do not purchase health insurance or have
coverage through their employer or Medicare will pay a tax penalty. For an
individual, the tax starts at $95 a year or up to 1 percent of income, whichever is
greater, and by 2016 rises to $695 per individual or 2.5 percent of income. For a
family, the tax is capped at $285 in 2014 and rises to $2,085 or 2.5 percent of
income in 2016. The Internal Revenue Service will collect the penalty via tax returns.
Q: How do I sign up?
A: Enrollment process is easy and you can choose the method that works best for you:
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Online at https://www.coveredca.com/. The website provides information about each
health insurance plan, explained in clear and simple terms. Individuals and small
business employers will know exactly what they pay and what they get before they buy.
By phone. Call the Covered California Customer Call Center at (888) 975-1142.
In person. Covered California Certified Insurance Agents and Certified Enrollment
Counselors are available in your community to provide expert advice and support. Find
one by calling (888) 975-1142, or through https://www.coveredca.com/.
By mail. Send application forms available at
https://www.coveredca.com/PDFs/English/paper_application/CASingleStreamApp_66MAX_092713.pdf to:
Covered California Service Center
P.O. Box 3530
Rancho Cordova, CA 95670-5667
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COA Fact Sheets
When you are ready to enroll, have the following:
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Number of people being enrolled (whole or partial family), including the birth date of
each person
Social security number(s) for each family member
Home ZIP code
Most recent income tax filings, including dependent tax information and head of
household status (if any)
Legal immigration information, such as your immigration number
Information about your status as a member of a federally recognized tribe
Q: When is the deadline to sign up?
A: For individuals, you have until December 14, 2013, to enroll for coverage that
starts on January 1, 2014. Open enrollment for Covered California-offered
policies effective in 2014 ends March 31, 2014.
Small employers can enroll for coverage through Covered California throughout
the year.
Q: Where can I get more information?
A: For more information, visit the Covered California website.
Resources
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Covered California, e-Health Insurance Companies for 2014: Making the Individual
Marketing in California Affordable
Covered California e-Small Business Health Options Program (SHOP)
Covered California “Getting Financial Help” fact sheet on premium assistance
Covered California “Getting Yourself and Your Family Covered” fact sheet on cost
sharing and premium assistance for individuals and families
Covered California income guidelines for health care premium subsidies:
Covered California “Shop and Compare Tool” to find out more about premium
assistance and how the sliding scale works based income
Preventive health services required to be provided at no charge to adults
Preventive health services required to be provided at no charge to women
Preventive health services required to be provided at no charge to children (18-years-ofage and under, depending on the service)
Covered California “Small Business Fact Sheet”
Covered California “Small Business Tax Credit” fact sheet on premium credits available
to certain small businesses
Covered California Frequently Asked Questions
Questions – more information
Questions on this topic are welcomed at the COA Member Resource Center staffed by
Jason Gabhart, COA external relations manager, or at 916-266-5043.
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COA Fact Sheets
© 2013 California Optometric Association. All rights reserved.
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