Public Comment to Covered CA Board Meeting 10.8.2015



I would like to address the issue of Certified Agents being forced into slavery by having us enroll Medi-Cal without being compensated for our time.


It’s not just filling out a Covered CA application, but explaining the benefits, how to use the plan, pick a doctor, verifying MAGI and so much more.  Plus, it’s a malpractice lawsuit waiting to happen.  Why is it that agents have to post a $2m  Insurance Policy and if Covered CA or Medi-Cal makes a mistake, will they claim Government Immunity?  We WASTE so much time filling out applications that could easily and are filled out by the public as very few people can figure out how to appoint us as their agent.  Maybe we could do Pro Bono work, if we weren’t wasting time!  We were promised in training that all enrollee’s would have to select or decline an agent in the ONLINE enrollment process.  Give us an affiliate link, just like ALL the Insurance Companies do OUTSIDE the Exchange!


If we are FORCED into slavery, at least give us the tools to do the job right.  I have the LEAD website for those who want to know about Medi-Cal redetermination.  See screen shot below.  While I might be in #4 position, the DHCS material is out of date! Or doesn’t work.  Sure, I have a degree in Insurance from San Diego State, CPCU, RHU, REBC etc. but why do you expect me to work for FREE and do stuff that Covered CA and Medi-Cal can’t or isn’t.  I will grant that Ms. Marean-Williams of DHCS did write the summary that I cut and pasted into my site.  But hey, it’s bad enough how many of MY pre Health Care Reform clients Covered CA STOLE from me by advertising that agents were no longer needed and just come and do your application ONLINE, direct.  Heck, here’s a prospect that I play Tennis with, who was given the WRONG information and I told him so, but still thinks that going direct with Covered CA is the best thing!    I also resent the number of Facebook friends I’ve lost as they feel Medi-Cal and subsidies are great, but no agent should dare advertise or inform the public of anything against the sanctity of President Obama.


We don’t even have a contact sheet for Medi-Cal or any sales material to explain how to use the plan or anything!   I recently had a guy come in who told me over the phone he earned $18k.   Turns out it was only $13k.   I allowed him to use an extra computer to enroll online at   but that didn’t work.  So, I enrolled him through my Covered CA portal and updated my website after hearing back from Medi-Cal.  The portal said he was incarcerated.  See screen shot below.  Now, you’ve made me an Immigration & Parole Officer without the benefit of a Firearm.  I spent say 30 minutes on the phone & email prior to our meeting, one hour enrolling and explaining… 20 minutes checking and explaining that Covered CA said if they didn’t believe he was NEVER in jail, Medi-Cal would call him or me.


See the link   where a woman found out that her child’s survivor benefits don’t count in MAGI for Medi-Cal and now I will have to give back all the service fees, plus read all her emails on how terrible the Social Services are and no one can tell her anything!   Do you expect me to know all these rules when I’m not being compensated or in the 8 hour in person training where ½ the material was incorrect!  Nor did we even get a free lunch.


So, PLEASE if Covered CA is happy to STEAL my clients from Pre Health Reform, then let Medi-Cal write these people that qualify up too.   At least Blue Cross and Shield allowed agents to keep their clients, but what about the husband and wife AB 1672 groups, those with Pacificare – UHC, Aetna, Health Net and those that may have switched from Blue Cross to Shield or vice versa?


I’ve asked Covered CA a dozen times about affiliate links, have those been forwarded to you?




Email us [email protected] if you want the screen shots or just wait till my comments are posted on Covered CA’s Board Meeting website.   Also see the analysis of the Board Meeting at Insure Me

October 1st Updates

Hi all,

It looks like it’s going to be a hectic last quarter.  Please be sure to email us ASAP so that we can help you pick the best solutions for your specific situation.

Grand Mothering for Small Group Health Insurance ends December 1, 2015.    Unfortunately,  President Obama’s promise of lower rates didn’t work out.  Many Employers may see 50 to 90% rate increases.   Free Quotes are available by sending your census or entering it ONLINE.   We are sending out direct mail to let Small Employers know.

Medicare Advantage information for 2016 will be available October 1st, with enrollment starting October 15th.

Individuals and Families will have their Open Enrollment starting 11.1.2015.   Blue Cross and Blue Shield’s information has just been posted.  Assurant is leaving the CA Market Place.   A new plan, Oscar is coming in.   UHP – Pacificare who left in 2014 is coming back on a limited basis.  Watch our Individual website for updates.   A few minor changes have been made to Enhanced Silver and the Metal Level Benefits.  If you qualify for tax credits we have that information here.  The penalty for not having coverage in 2016 increases to 2.5% of income.   Life, Disability, Retirement and Long Term Care are NOT covered!  Email me to discuss those vital c overages in January we things slow down.

Narrow lists have been quite problematic and confusing.  I thought President Obama promised if we liked our doctor we could keep him.  Here’s our links to all the provider lists.   The CA Health Care Foundation just came out with a 20 page report on the issues of accurate lists.  CA DOI, Dept of Managed Care and Consumer Reports just came out with a new tool to estimate your costs for health care.

I know we don’t post that often.  I find it much easier to find the pages that need to be updated with the latest information in the static pages as they are more hierarchical.   Here’s the XML Site Maps that Word Press automatically makes to let the search engines know of all the new content on our website.  We update constantly.


Links to Updates on our websites


Sorry, it’s been a while since we posted the updates to our websites.  Most of the changes and been for more clarity and understanding as opposed to anything truly newsworthy.



health reform
grandfathering/   – Grand Mothering – Loss of privileges coming up?
life-and-estate-planning/ reform
strategic-planning-medi-cal/ 100% 2 Weekly 2015-05-24 01:25


What’s new March 5, 2015

Here’s the changes and updates on our websites for the past two weeks or so.  We use pages as opposed to posts so that information is easier to find and update in a hierarchical structure rather than posts.


The changes include, clarifications and updates on tax subsidies taxcredits.  for Individual Premium, how to file taxes 2014-tax-forms-subsidy-verification-filing/  and the Supreme Court Decision court-rulings-subsidies/ on if subsidies will be allowed…  Open Enrollment open-enrollment-for-individuals-families/  has been extended if you didn’t know about the tax penalty.  We’ve posted updates on  special-enrollment-triggering-events/ if you need to change something…


Now is a good time to look at coverages other than Medicare and Individual Health, like Long Term Care long-term-care/    long-term-care/employer-groups/  can take a tax deduction on the premiums,  as we have more time to work with you, since the alligators are not bothering us at the swamp.


Tax Subsidy – Obamacare  URL


Individual & Family Website   URL





Enhanced Silver….   URL


Life, Long Term Care, Disability —-  URL





Medi-Cal     We don’t get paid to help people on this one…    URL
Condo Law & Rules  URL






Health Insurance Law—-URL


General Law    URL

Website Updates

Blue Shield notification of 2012 MLR Rebates & FAQ’s

Kaiser OFFER for early renewal – take longer to review 1.1.2014 changes

IRC 101 A Citation added – No income tax on Life Insurance Proceeds

Blue Shield Flyers added to

Small Group Tax Credit Page     Rating Factors Small Group     Shop – Covered CA

Financial Impact of Health Care Reform    Small Biz   Health Care Reform 

Covered CA – Individual

Individual & Family  

Essential Health Benefits

HIPAA guaranteed issue after COBRA

Added an FAQ section

Updated Rising Rates Page – including LA Times 7.24.2013 article on Kaiser’s Rates and new CA bill for more transparency

Nutrition Page – 1st lady’s efforts stumble

HHS report that premiums in exchange will be 18% lower

Updates and how to qualify for Medi Cal expansion 2014



NEW Business Start Ups?

With Guaranteed Issue Coverage coming 1.1.2014 many employees may leave their jobs to start new businesses. has been helping Small Biz with 2 or more employees in CA get guaranteed coverage since 1992 under AB 1672, Mr. Mip for individuals if they had no place else to go and HIPAA for those who have exhausted COBRA.    We welcome NEW start ups.  Free IndividuaBusiness  Quotes

It’s our opinion that under Health Care Reform that ONE employee business, even if it’s just the owner can get GROUP coverage.  There is  some dissenting opinion.  We’ve sent a email to Covered CA for clarification.



‘Employment Lock’ May Be Coming to an End

Meanwhile, a new paper explores the phenomenon of “employment lock” — where workers stay in jobs they don’t like because of the health benefits — and concludes that given the new security of coverage expansion under the ACA, as many as 940,000 Americans will leave their jobs.
(CA Healthline)


Subsidy – Income WILL be verified in 2014

Subsidies and Actual MAGI Income will all come out in the wash when 2014 taxes are filed!

It’s been announced that the Exchanges won’t verify your income the 1st year when you complete the forms to qualify for subsidies – tax credits under Health Care Reform for Mandatory Coverage starting 1.1.2014.  There is a $25k penalty for willfully misstating income.  There is some talk that the CA Exchange will be verifying income. The final rule allows each state – discretion.   I’m not sure yet.  Subscribe to our blog and when it’s certain, you will know.  Also watch our Tax Subsidy and Covered CA pages.

BNA 8.9.2013 Update

The author of the BNA article thinks for most people, it’s going to mean the exchange will tell them, ‘go get a pay stub and fax it to us.

Centers for Medicare & Medicaid Services released guidance Aug. 5

CMS’s release in July of a comprehensive final rule (CMS 2334-F)

Limited Exception to Requirements

CMS said “for 2014 only,” it will permit state-based exchanges (not the federally facilitated exchange) to bypass the full income verification requirements when all the following factors exist:

• the exchange has income information from the IRS;

• the applicant reports projected annual household income more than 10 percent below the most recent data available from IRS and SSA;

• Equifax data from an employer is unavailable; and

• the applicant does not provide a reasonable explanation for the inconsistency between what he or she reported and IRS and SSA data.

“In all other cases in which the data submitted by the individual cannot be verified using IRS and SSA data or Equifax data, and the individual does not provide a reasonable explanation for any discrepancy … the marketplace must request additional documentation,” the guidance said.

It emphasized that applicants must attest, under penalty of perjury, that they are not providing false or fraudulent information to the exchange. The guidance also noted that IRS will require repayment of tax credits if an applicant’s income for the year following receipt of the credit shows the applicant is not eligible.

See below for references.

Life Health Pro 7.8.2013 Announcement

Final Rule  600 Pages
We will be putting this on our website with bookmarks and highlights…subscribe to our blog for notification

Covered CA – OUR Website

Tax Credit Calculator

Covered CA Explanation of Tax Credits  pdf – Take them now or later? (With our bookmarks and highlights – Educational purposes ONLY!)

Cut the Cost Tax Credit

Get Quotes NOW

Myths from Official Government and Respected Sources SBA


I haven’t been blogging much lately.  I feel that it’s better to just update or add a new webpage for the current information on how to get coverage under Health Care Reform or Life, Long Term Care, Medicare that wasn’t affected.   Here’s an update on the situation about the government or their entities misinforming the public and preventing any corrections.  This is a copy of the email I’m sending to Covered CA.   



 I posted a link on Covered CA’s Facebook page, to my webpage with the PCIP and Mr. Mip brochure application and now I’ve been blocked from commenting.  My posting was in response to a visitor’s comment that one could not get any coverage if they had a pre x in the past.  The post was certainly NOT advertising, as PCIP failed and Mr. Mip will soon be moot, if not now, due to the 3 month pre x period.

 Sometime back, I went to a Town Hall led by Congresswoman Janice Hahn, where the Rep. from the SBA stated that under current law, one could not get ANY coverage at all if they had a Pre X condition and that Small Biz could be denied for Pre X.  When I raised my hand to correct this, I was rudely informed by an aide that I couldn’t interrupt the SBA.  In addition, the rep. from Small Biz Majority sent me an email that one must NEVER interrupt anything from a well-respected Congresswoman.   I’ve asked for a refund of my last campaign donation, as Ms. Hahn’s office never contacted me for further information, as promised on AB 1672 or Mr. Mip.

When I went to the Covered CA licensing seminar in Culver City, several of the questions that were answered were incorrect.  I have not had a response from Covered CA on those emails.   I did get a response to the new definition of Employer from the Facebook page though.

 Maybe Health Care Reform would be working better, if the legislature understood current law and practice and if the public was not deliberately misinformed, in violation  of our trust in our leaders and law.

 I will be posting a copy of this letter to my blog, where you are welcome to respond.


Be careful, many of the myths and misinformation are coming from official sources.  I saw an example at a seminar today.  If a LICENSED agent did this, there would be severe repercussions, even the loss of their license for 3 years.  There are also penalties if ANY person…misrepresents coverage.

Highlighted and bookmarked pdf

The CA Dept. of Insurance is very concerned about unlicensed persons helping the public get enrolled and the potential for fraud when they ask for  your personal information.  CHCF 7.15.2015

Excerpts from SBA Fact Sheet  

For the first time, individuals and business owners are able to make side-by-side comparisons to find a plan that fits their budget and that’s right for their families, businesses, and employees.

Quote Engines showing prices and comparisons for families and business have been on mine and dozen of  other agent websites for years.

CA Law since 1992 AB 1672 Insurance Code 10705  (5) (d) (1) requires agents and insurers if requested  to show all plans offered by the carrier the agent is presenting.

The exchange will not be showing all the plans being marketed, as some carriers did not choose to be in the exchange or the exchange didn’t think they qualified.

“80/20” rule requires that at least 80% of premium dollars collected by insurance companies for individuals and small employers must be spent on benefits and quality improvement.

This is good…. but it was pretty much the case in CA for years, with Insurance Companies being mandated to inform the public of their loss ratio. (Citation to follow)   More on Medical Loss Ratio in Health Care Reform

On October 1st, individuals and small businesses can buy affordable benefit plans by enrolling in the new Individual and Small Business Health Insurance Options Program (SHOP) Marketplaces.

I don’t know if we can call this misrepresentation… but all the plans offered in the exchanges, must also be offered outside the exchange, so why not let the public know?  Also, this is from the SBA whose mission is

The voice of small business on Capitol Hill since it was created in 1976, the Office of Advocacy works to protect, strengthen and represent the interests of the nation’s small businesses within the Federal Government. (

So, wouldn’t you think they would support the Small Biz Insurance Agents rather than telling the public to go to the exchange and bypass Small Biz?  Congress recognizes the value of agents.  Especially since there is no extra charge!

The slide show did mention that agents had a role in the SHOP program for Employer Groups.

There was other misinformation presented at the seminar that I went to, but I don’t have it in print. 

The SBA said that Small Biz currently could be DENIED coverage if there were Pre Existing conditions,

this is not true.  AB 1672 10705 (g)

They also said that the SHOP program required two or more employees.

Covered CA states on their website:  Covered California is developing a marketplace specifically designed for small businesses with one to 50 eligible employees.  See our blog for citation showing that a single owner – sole proprietor is an employee under AB 1083

When I asked for clarification on sole proprietor businesses, the representative from www.SmallBusinessMajority gave me an incorrect and condescending reply. She also stated both verbally and in writing that I should never bring up anything wrong in front of an elected public official.  I’m not posting that email, as I expect a retraction.  I also asked for the exact citation as to why the representative thinks my reading of Black Letter  law is incorrect.

The public official is not being named as I am NOT making any formal complaints and the public official had two staff members ask me about AB 1672.  Google recognizes me in the top 5 unpaid listings for this law, at least until I started this new website and haven’t finished all the 301 redirects.  The public official specifically told a staff member to contact me next week for further clarifications.

On the other hand it’s been reported –

Michael Lujan was very explicit in 2 presentations to CAHU and LAAHU, an EE is someone who is listed on a DE9C.  Sole Proprietors and partners are normally not on a DE9C.  The sole prop and partner can be included in a group plan IF they have at least one W2 EE listed on the DE9C.  


On the website they tell you that if you currently do not have coverage and have Pre X conditions to check out PCIP.  They don’t tell you that PCIP STOPPED writing new business back in March

Nor do they mention MR MIP, which the SBA implied did not exist, as they said there was presently no way for uninsurable individuals to get coverage.

I will grant that keeping a website up to date is tough.  My new website allows for comments on every page.  If you see something that needs correction or clarification, please let me know.

I trust the SBA and will make the corrections on their website and before they make any further presentations.  I will send their representative a copy of this post. 

I welcome any corrections or explanations anyone might have.  I do ask that if any “FACTS” law or regulations are mentioned,  that the URL to the law… be given for the post to be approved.



Myth – Employers will stop covering employees!


Myth: Employers will stop offering health coverage to their workers under the Affordable Care Act.

Fact: Multiple independent analyses by organizations, including the RAND Corporation, Urban Institute and Mercer, have found that employers will continue to offer health coverage to their workers under the Patient Protection and Affordable Care Act. And there’s real-life evidence to support this conclusion: When health reform was enacted in Massachusetts, the number of businesses offering insurance in the state actually increased.

Read the RAND Report
Read the Urban Institute Report
Read the Mercer Report


Click here for FREE quotes for Small Employer Coverage.