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Covered California
P.O. Box 989725
West Sacramento, CA 95798-9725
{FIRST_NAME}{LAST_NAME}
{ADDRESS_LINE1}
{ADDRESS_LINE2}
{CITY}, {STATE_CD (FK)} {ZIPCODE}
<Notice Date> Case Number: <Case #>
Dear {FIRST_NAME} {LAST_NAME},
You are getting this letter because, in <previous benefit year>, you or members of your
household are enrolled in a Covered California dental plan. It is almost time for your
dental insurance coverage to be renewed. Renewal for your household is due by <notice
date + 30 days >.
When you renew your dental insurance, you will be able to:
Let Covered California know if your application information has changed
Find out if your monthly premiums have changed
Note: If someone in your household has Medi-Cal, your local county social services office may
contact you for more information. To help them keep Medi-Cal, you will also need to provide any
information your local county social services office asked of you.
The Renewal Period allows you to renew your dental insurance in the same dental plan.
You must be enrolled in a health plan through Covered California in order to choose a
different dental plan. If you wish to add a health plan during the Open Enrollment Period,
you may make changes to your dental plan at that time. For more information on how to
Get ready to renew your dental insurance
for <Next Benefit Year>!
Your destination for quality
healthcare, including Medi-Cal
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renew your insurance, read the “How do I renew my insurance now?” section of this
notice.
Family Dental Plan Enrollment
All Covered California health plans include pediatric (children’s) dental coverage. You do
not have to buy a separate dental plan for your children when they are enrolled in a
health plan.
Family Dental Plans offer optional coverage at an additional cost. Premium assistance is
not available for Family Dental Plans.
What if I do not renew my insurance?
If you do not renew your insurance, Covered California will automatically re-enroll you or
members of your household into your current dental plan by December 15, <current
year>, if you remain eligible and your plan is still available. We will renew your insurance
using the most recent information in your application.
What will change for you next year?
The Amount of Premiums You Pay
The amount you pay for dental coverage may change each year. You will receive a letter
from your dental plan carrier in the fall. The letter will show your new monthly premium
amount for <next benefit year>. Make sure to pay your premium directly to your dental
plan carrier by the due date so your coverage can start on January 1, <next benefit
year>. Please do not send your payment to Covered California.
If you change your plan after December 15, <current year>, your coverage date will
change.
For <previous benefit year>, you chose <Dental Insurance Plan Name, e.g. Delta
Dental Family Dental PPO>. You will receive a letter from <Dental Insurance Company>
in the fall that will show your new monthly premium amount for <next benefit year>.
Make sure to pay your premium directly to your health or dental plan carrier by the due
date so your coverage can start on January 1, <next benefit year>.
How do I renew my insurance now?
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To renew the insurance for your household before <notice date + 30 days >, follow the
four steps below:
Step 1: Log in to your CoveredCA.com account
Step 2: Click the yellow “Continue” button
Step 3: Check your application information
Make sure your information is correct by <notice date + 30 days> to get the coverage that is
right for you. If your application information has not changed, confirm your current information by
clicking “Continue” until you get to Step 4 (see below).
Changes to your household could open more options.
Certain changes in your household may change what benefits you or your family are eligible for.
Although you are not able to make changes to your dental plan until the Open Enrollment
Period, this is an opportunity to update changes within your household and review the other
programs Covered California has to offer. You may qualify for health coverage with financial
assistance. To make sure your health coverage is still affordable, you must report changes in
your household to Covered California within 30 days of the change. Examples of changes that
must be reported to Covered California include:
The number of people in your household went up or down during the year
Your household income goes up or down
Moving to a new place
Qualifying for other coverage, such as Medicare, or coverage through an employer
You can report any changes when you log into your account at CoveredCA.com or by calling the
Service Center at 1-800-300-1506 or (TTY: 1-888-889-4500).
Once you report your changes, your household may qualify for different programs or
health plans available through Covered California. If you agree with the decision that we
made when we processed your changes, you can choose your health and dental plans
during the Open Enrollment Period by <notice date + 30 days >. You will pay your
premium directly to the health and dental plan carriers. Pay by the due date so your
coverage can start on January 1, <next benefit year>. You may contact your health or
dental plan carrier, or wait for them to bill you. Please do not send your payment to
Covered California. To report changes, you can also call the Service Center at
1-800-300-1506 or (TTY: 1-888-889-4500).
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Note: If you or someone in your household has Medi-Cal, report changes to your local
county social services office within 10 days.
Step 4: Shop and pick the best plan for you
Once you confirm your application information, you will be able to stay in your current
dental plan. If you remain eligibile and do not choose a new health or dental plan by
<notice date + 30 days>, we will keep you in your current dental plan if it is available. Or,
during the Open Enrollment Period you can compare rates and shop for a new health or
dental plan. If you are thinking about changing plans, you may want to check whether the
plans you are looking at have your current dentist, doctors or hospitals. At
CoveredCA.com, there are links to each plan provider directory. There you can check to
see which doctors are available.
What if I want to change plans after <notice date + 30 days>?
If you change your mind and want to pick a new plan after <notice date + 30 days>, or if
you did not pick a plan last year be sure to choose one before the Open Enrollment
Period ends. The <next benefit year> Open Enrollment Period is from <OE begin date>,
<previous benefit year> to <OE end date>, <next benefit year>. Open Enrollment
Period allows you to:
Change your health or dental plan for any reason
Add new members to your coverage
Enroll in a health or dental plan
During the Open Enrollment Period, you can:
Go online to CoveredCA.com and log in to your Covered California account.
Call our Customer Service Center at 1-800-300-1506 or (TTY: 1-888-889-4500).
Starting now and until the end of the Open Enrollment Period, the Service Center
has extended hours.
Get free help in person from trained Certified Enrollment Counselors and Certified
Insurance Agents who can help you. See “Do you need help?” below.
Please remind your family and friends that the Open Enrollment Period is coming and
send them to CoveredCA.com.
Do you need help?
Covered California wants to make renewing your coverage as easy as possible. A Covered
California Certified Enrollment Counselor or Certified Insurance Agent can help you.
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Use this snippet if the consumer did not have a counselor or agent
<Do you have an Enrollment Counselor or Agent? To find an Enrollment Counselor or Agent
close to your home, go to CoveredCA.com and click on Get Help. Or call the Covered California
Service Center.>
Use this snippet if the consumer already has a delegated counselor or agent for<previous
benefit year>
<Our records show that you were helped by a Covered California Certified Enrollment Counselor
or Agent from {Entity Name or Agent Name}.You may reach your Certified Enrollment Counselor
or Agent at:
{Entity Name or Agent Name}
{Entity/Agent Address Line 1}
{Entity/Agent Address Line 2}
{Entity/Agent City}, {Entity/Agent State} {Entity/Agent Zip Code}
{Entity/Agent 1Phone Number}
{Entity/Agent Email}>
Why is it important to have health insurance?
Health insurance helps make sure you get the care you need to keep your body healthy and it
gives you peace of mind because you know you will have help when you need it.
The law requires that most consumers must have health insurance. This may be through your
employer, coverage you buy for yourself, or coverage you get from Medicare or Medi-Cal.
Consumers who do not have health insurance may have to pay a penalty called a “shared
responsibility payment” that increases each year up to a maximum amount.
For example, the chart below shows the penalty with the maximum for an uninsured household
of four:
Year
How the fee is calculated
2015
2% of the annual household
income or $325 per adult
($162.50 per child under 18) up to
$975 for a family.
You will pay whichever of these
amounts is higher.
2016
2.5% of the annual household
income or $695 per adult
($347.50 per child under 18) up to
$2,085 for a family.
You will pay whichever of these
amounts are higher.
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If you are uninsured for just part of the year, you pay 1/12 of the yearly penalty for each month
you are uninsured. You will have to pay the penalty when you file your federal income tax return
for that year. If you are uninsured for less than 3 months, you do not have to pay the penalty.
Remember: if you are uninsured, you also pay 100% of your medical costs.
Do you have questions?
Visit the CoveredCA.com website for more details.
If you have created a CoveredCA account, log on to your account at
CoveredCA.com; or
Call the Covered California Service Center at 1-800-300-1506. You can call Monday
through Friday 8 a.m. to 6 p.m. During certain times of the year, the Service Center
may be available Saturdays 8 a.m. to 5 p.m. The call is free.
This letter is being sent to you in compliance with the Affordable Care Act:
45 CFR §155.335(c) Notice to enrollee and Cal. Code Regs., tit. 10, § 6498(e).