IEHP Covered FAQ

IEHP Covered:

Frequently-Asked-Questions Overview: Starting January 1, 2024, IEHP will will be offering Covered California health plans to Inland Empire residents. Covered California is a commercial health insurance exchange where people can go to purchase low cost health insurance. While there are many plans to choose from on the exchange, we are very pleased to offer the lowest cost Silver plan in addition to other options. This means any Medi-Cal recipient in San Bernardino and Riverside counties who unfortunately loses their eligibility will be automatically selected for IEHP’s Silver Covered California health plan, officially called “IEHP Covered.” IEHP’s entry makes us the second public managed care plan in the state to join the exchange. Joining Covered California is a crucial move to ensure access to quality health care for our members and the community.

Q Is Covered California the same as Medi-Cal? A No. While they both cover the 10 essential health benefits and use the same application, Medi-Cal offers

free health coverage – it has no premium, no co-payments and no out-of-pocket costs. Covered California offers financial assistance or subsidies to help reduce monthly premiums, co-payments and out-of-pocket costs. However, there are many benefits that most Covered California enrollees can get at no cost.

Q Is Covered California a health plan?

A

No. Covered California (aka, the exchange) is an online marketplace where people can shop, compare, and purchase various private health insurance plans for individuals, families and small businesses. It is California’s equivalent to the federal health insurance marketplace from the Affordable Care Act.

Q Who is eligible for Covered California?

A

Any legal resident of California can apply for health coverage through the Covered California health insurance marketplace. For IEHP Covered, subscribers must be a resident of the Inland Empire.

The following individuals and lawful spouses are NOT eligible: • Individuals who are incarcerated.

• Individuals eligible for a group plan with minimum essential coverage.

• Individuals, including dependent parents and stepparents aged 65 years or older, eligible or enrolled in Medicare benefits.

• Individuals eligible for Medi-Cal or other state or federal programs.

Q When can individuals and families begin to apply for Covered California?

A

Open Enrollment for the upcoming 2024 plan year runs from Nov. 1, 2023 – Jan. 31, 2024. However, for those who are already in a Covered California health plan and wanting to switch into IEHP Covered, they can begin the application with IEHP beginning Oct. 1, 2023. Outside of Open Enrollment, a person will have to experience a life-changing event, triggering a Special Enrollment Period (SEP), during which they can enroll into a Covered California health plan.

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IEHP Covered: Frequently-Asked-Questions (continued) Q If someone’s Medi-Cal is discontinued, can they enroll in Covered California during a Special Enrollment Period (SEP)?

A

Yes, if Medi-Cal coverage is discontinued, that is considered a qualifying event that triggers a Special Enrollment Period (SEP), but to avoid a gap in health coverage, a person should choose a Covered California plan before their Medi-Cal ends. Any Inland Empire Medi-Cal recipient who loses their Medi-Cal will be auto-selected into IEHP Covered’s lowest cost Silver plan, however, they must confirm their enrollment.

Q What also qualifies as a SEP event?

A Other life events that would trigger a SEP include: • Permanently moved to/within California • Lost or will soon lose their health insurance, including Medi-Cal eligibility, also known as loss of Minimal Essential Coverage (MEC) • Had a baby or adopted a child • Got married or entered into a domestic partnership • Domestic violence survivors (If married, abuser’s income not counted if survivor lives apart and is unable to file joint tax return) • Returned from active duty military service • Released from jail or prison • Gained citizenship/lawful presence • Federally Recognized American Indian/Alaska Native • Other qualifying events as identified on the Covered California portal

Q How does IEHP Covered impact IEHP’s current members?

A IEHP Covered will not impact our current members or current plans. It will provide another option for

future members and existing members who can no longer qualify for our other plans. If a member no longer qualifies for Medi-Cal with IEHP, they will be auto-selected into Covered California’s lowest cost Silver plan through IEHP Covered.

Q Is the lowest cost Silver plan the only plan we will be offering through Covered California?

A

No. While the lowest cost Silver plan is the most popular plan on the Covered California exchange, IEHP Covered will include all other mandated plans on the Covered California exchange.

Q What are the other plans offered through IEHP Covered?

A

IEHP Covered will offer the standard benefit plans at each “metal” level, plus a Catastrophic plan.

Metal plans are separated into Bronze, Silver, Gold, Platinum.

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IEHP Covered: Frequently-Asked-Questions (continued) Q How much does IEHP Covered cost?

A Costs vary according to the plan chosen and the income of each subscriber or the amount of subsidies that subscriber qualifies for.

• The Bronze plan covers, on average, 60% of costs; the subscriber pays 40%. It offers free services for preventive services and protection in case “something goes wrong.” It has the lowest monthly premium but high deductibles.

• The Silver plan covers 70 to 94% of costs; the subscriber pays the remainder. It’s good for moderate users of health services.

- Silver 70 covers 71.80% • The Gold plan covers 80% of costs; the subscriber pays 20%. It’s good for moderate or heavy users of health services. It has higher monthly premiums, but when care is received, the costs will be lower.

• The Platinum plan covers 90% of costs; the subscriber pays 10%. It’s good for individuals who use health services often. It has the highest monthly premiums, but when care is received, the costs will be lowest.

• The Catastrophic plan has the least expensive premium but has the highest deductible and is mostly to protect individuals from “worst-case scenarios.”

Q Will IEHP Covered have the same provider network as Medi-Cal and IEHP DualChoice (HMO D-SNP)?

A

No, IEHP Covered’s provider network will be different from the provider network for Medi-Cal and IEHP DualChoice (HMO D-SNP).

Q Is there Continuity of Care (COC) with IEHP Covered?

A Yes. California law allows newly enrolled members with qualifying medical conditions to continue to

receive medical services from their previous provider, even if the previous provider is an Out-of-Network (OON) Provider.

Q How does a person enroll into Covered California or IEHP Covered?

A There are many ways to enroll. They can call an IEHP enrollment specialist at 855-538-IEHP (4347).

They can also visit CoveredCA.com to enroll online.

Q What makes IEHP Covered different from other health plans that offer Covered California?

A

Members of IEHP Covered have access to our Community Resource Centers (in San Bernardino, Riverside and/or Victorville) for free exercise classes, community activities and learning opportunities. Plus, our helpful customer support team members, who live and work in the Inland Empire, and are committed to live the IEHP mission, “to heal and inspire the human spirit,” by placing members at the center of their universe.

Q Where can I go to learn more about IEHP Covered or Covered California?

A Learning and Development will be giving all IEHP team members in-depth training and education on IEHP

Covered. The course will be coming soon. Check LMS for updates. You can also visit the IEHP Covered website at IEHP.org or on JIVE at https://jive.iehp.org/community/operations/covered-california/activity.

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