Employer Begins Process with Issuer (Insurance Provider)
- Step 1: Employer calls issuer or agent/broker wanting more information about Covered California for Small Business
- Step 2: Employer downloads PDF application on Covered California or on website of issuer or agent/broker. Issuer, agent/broker or employer, fills it out and sends in application to the Marketplace
- Step 3: Issuer has employer complete issuer-specific enrollment process and provides employer or agent/broker with exact premium quote
- Step 4: Issuer accepts enrollment based on a provisional Covered California eligibility determination. Alerts employer Covered California will send an official eligibility notification
- Step 5: Issuer collects first month’s premium payment by the coverage effective date. If employer fails to make initial payment or issuer determines a group may not enroll, issuer calls Covered California employer contact center about status of account
- Step 6: Issuer notifies employer and employees of successful enrollment in QHP and/or QDP
- Step 7: Covered California reviews application when it arrives and makes an eligibility determination by ensuring employer has attested to eligibility criteria and signed the application
- Step 8: Covered California calls employer and sends official eligibility notice. If employer is deemed ineligible, then Covered California will notify employer and provide appeals information. Covered California will also notify issuer about status of account. Issuer may transfer enrollees to non-Covered California plan if they are determined not eligible for Covered California
- Step 9: Covered California verifies employee eligibility and QHP and QDP enrollment on monthly audit file
- Step 10: Employer contacts issuer to add or drop employees and dependents
- Step 11: Covered California updates employee roster after receiving monthly audit file and contacts employer to verify enrollment changes
- Issuers may direct employers and agents/brokers to the Marketplace if they do not want to start the enrollment process without a Covered California eligibility determination