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Anthem Blue Cross
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Blue Cross California HIPAA Rates, Coverage
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Effective Dates from October 1, 2010 forward

Those who submit, or have postmarked, an application and payment between the 1st and 15th of any given month will be assigned an effective date of the 1st of the following month. For example, if an applicant sends in the application and payment on October 12, 2010, the earliest effective date they can have is November 1, 2010.

Those who submit or have postmarked an application and payment after the 15th of the month, will be assigned an effective date of the 1st of the second following month. For example, if an applicant has the application and payment postmarked on October 25, 2010, the earliest effective date they can have December 1, 2010.

Please note: The applicant’s option to request an effective date was removed from the application. We recommend applicants apply 30-60 days before the end of coverage to avoid a lapse in coverage.

Is this where such restrictive working came from?
See also Small Group AB 1672

Anthem has a newer rule regarding HIPAA start dates when the application is rolled over from a decline through underwriting.

The new rule is that the premium authorization for the underwritten application must be authorized verbally or in writing to be applied to the HIPAA rollover, it’s not automatic anymore.

The bigger issue is that when the app rolls over from decline to HIPAA, Anthem no longer allows the premium date of the original application to count towards the premium submission for the HIPAA rollover.  As an example, someone borderline HIPAA  with COBRA expiration of 10/31 applying 10/5 for Smart Sense and declined 10/15 the rollover would be after 10/15 so even if the premium rollover is authorized by note or letter, the open of the HIPAA app is considered after 10/15 and thus the start date is pushed to 12/1 and they gap a month.  There is no workaround for this situation.

If the COBRA expiration is closer than 60 days and they are a possible decline and HIPAA, I believe it best with Anthem at this point to write it HIPAA first then try underwriting later.

My RSM told me yesterday that this has been an unannounced procedure for well over six months.  But he also told me that you could preserve the premium submission date by adding a note in the additional comments section of the online app or with a paper application indicating that it is OK to use the same premium payment method for HIPAA.

Today, Support told me that was not true and that the HIPAA rollover application would only be considered ?received? when the HIPAA unit opens the HIPAA app (new ID #).  That is the point where the premium rollover authorization from the original IFP app gets date-credited.

It used to be lock in from the date of the IFP application including credit for premium submitted but Support told me they changed it Sept 2010.
From a friendly competitor

Effective Date Details
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Blue Cross HIPAA Brochure

Please note that premium or authorization, sent in with a standard application, does NOT count for HIPAA!

Sample request for HIPAA payment

More detail on effective dates

To try to insure there is no lapse in coverage the client will need to obtain all required documents prior to the end date of their current coverage. Blue Cross email dated 6/1/2010

Evidence of Coverage EOC

HMO saver

select HMO 25

basic PPO 1000

ppo share 5000

PPO Share $1,500
Addendum

Blue Cross information on DMHC Website

Evidence of Coverage

effective date

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