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Right to view FULL Policy – E O C (Evidence of Coverage) prior to purchase Health Insurance

California Insurance Code §10276

Every individual accident and health policy or contract, except single premium nonrenewable policies or contracts, issued for delivery in this state on or after July 1, 1962, by an insurance company, nonprofit hospital service plan or medical service corporation, shall have printed thereon or attached thereto a notice stating that the person to whom the policy or contract is issued shall be permitted to return the policy or contract after its delivery to the purchaser and to have the premium paid refunded if, after examination of the policy or contract, the purchaser is not satisfied with it for any reason. The period time set forth by the insurer, nonprofit hospital service plan or medical service corporation for return of the policy or contract shall be clearly stated on the notice and such period shall not be less than 10 days nor more than 30 days. The policyholder or purchaser may return the policy or contract to the insurer, plan or corporation at any time during the period specified in the notice. If a policyholder or purchaser pursuant to such notice, returns the policy or contract to the company or association at its home or branch office or to the agent through whom it was purchased, it shall be void from the beginning and the parties shall be in the same position as if no policy or contract had been issued.

This section shall apply to all policies or contracts subject to this section and issued, amended, delivered, or renewed in this state on or after January 1, 1981. All policies or contracts subject to this section which are in effect on January 1, 1981, shall be construed to be in compliance with this section, and any provision in any such policy or contract which is in conflict with this section shall be of no force or effect.

1363(a)  (A) (i) the applicant has a right to view the evidence of coverage prior to enrollment, and, if the evidence of coverage is not combined with the disclosure form, the notice shall specify where the evidence of coverage can be obtained prior to enrollment.  1363 (A) (i)   

Every policy of individual life insurance shall have a notice stating that after receipt of the policy by the owner, the policy may be returned by the owner for  cancellation by delivering it or mailing it to the insurer or to the agent through whom it was purchased.  This period shall not be less than 10 days nor more than 30 days. CIC 10127.9.

 

Sample Policy Provision

YOU HAVE THE RIGHT TO VIEW THE AGREEMENT PRIOR TO ENROLLMENT.

ONCE ENROLLED, YOU HAVE THIRTY (30) DAYS FROM THE DATE OF DELIVERY TO EXAMINE THIS AGREEMENT. IF YOU ARE NOT SATISFIED, FOR ANY  REASON WITH THE TERMS OF THIS AGREEMENT, YOU MAY RETURN THE AGREEMENT TO US WITHIN THOSE THIRTY (30) DAYS. YOU, CONSISTENT WITH CALIFORNIA LAW, WILL BE REQUIRED TO PAY FOR ANY SERVICES ANTHEM BLUE CROSS PAID ON YOUR BEHALF DURING THE THIRTY (30) DAY PERIOD AND ANTHEM BLUE CROSS WILL REFUND ANY PREMIUM PAID BY YOU, LESS YOUR MEDICAL AND PHARMACY EXPENSES THAT ANTHEM BLUE CROSS PAID. IF NO SERVICES WERE RENDERED, YOU WILL BE ENTITLED TO RECEIVE A FULL REFUND OF ANY PREMIUMS PAID. THIS AGREEMENT WILL THEN BE NULL AND VOID.  (Page 18 Specimen Policy)

Free look  

Covered CA has a different Opinion.  IMHO they are in violation of law!

See  § 155.430  *   Termination of Exchange  enrollment or coverage  

(b)Termination events –

(1)Enrollee-initiated terminations.

(i) The Exchange must permit an enrollee to terminate his or her coverage or enrollment in a QHP through the Exchange, including as a result of the enrollee obtaining other minimum essential coverage. To the extent the enrollee has the right to terminate the coverage under applicable State laws, including “free look” cancellation laws, the enrollee may do so, in accordance with such laws.

Thank you for contacting Covered California™.  I apologize about the link.  Please see below for the article regarding the 14 Day Notice of Termination. 14 Day Notice for Terminations This article clarifies the policy for 14 Day Notice for Terminations and give examples.

  • Enrollees must generally provide 14 days advance notice to process requests to terminate enrollment in a health or dental plan through Covered California, with some exceptions.
  • Covered California may apply exceptions in some cases and terminate with less than 14 days’ notice as long as the termination date is end of the month.
  • Regardless of how many days of advance notice enrollees give Covered California, they are strongly recommended to make thier termination effective the end of a month, for the following reasons.  Before consumers terminate or attempt to terminate, inform them of the following:
    • Consumer usually pay in advance for coverage for the following month.  For example, you are billed in May for coverage in the month of June. If you terminate your coverage with less than 14 days advance notice, your health plan carrier may have already billed you for the following month’s premium or may not have enough time to cancel your payment for the following month if the monthly payments are automatically withdrawn from your bank account.
    • There is no legal obligation for the health or dental plan carrier to refund prorated premiums.  So if you call on June 1st and request a plan termination on June 15, your plan carrier is not required to refund you for the remaining days of June.
    • If you request a termination date in the middle of a month, you may have a gap in coverage because most health plans start on the first day of the next month.
    • For these reasons, if you need to terminate your health or dental plan, it’s strongly recommended that you request termination 14 days in advance so that it can be effective at the end of the month. The day of the call is counted as the first day of the request for termination.
  • Except in rare cases, terminations are always made with a future effective date.  State and Federal regulations allow Covered California to process requests to terminate past months of coverage in very limited circumstances, such as death and fraud.  If this is the case, follow the Escalations process. If this is not the case, review the 14 Day Termination Rule Talking points in this document and assist the caller in selecting a future termination date.

Less than 14 Day Notice for Termination of Health or Dental Plans There are some exceptions to the 14-day advance notice requirement.

  • If enrollees request an end–of-month termination with less than 14 days advance notice, inform them that while a 14-day advance notice is required in most cases, you will terminate the plan at the end of the month.
  • If enrollees request a mid-month termination with less than a 14-day notice, inform them that Covered California is unable to process this request without carrier approval and he/she must contact the carrier to receive an authorization.

Examples:

  • The enrollee contacts Covered California on…
    • September 25th to request termination of coverage.  He explains that his employer-sponsored coverage begins on October 1st and he wishes to cancel as of/before the new coverage goes into effect.  This would result in an end-of-month termination, and SCRs have been granted permission to terminate less than 14 days, if the enrollee requests it, and it results in an end-of-month termination.  You can process this termination with a termination date of September 30th.
    • September 25th to request a termination of coverage on the day of contact, September 25th. In this case, the consumer can choose to terminate at the end of month, September 30th, or 14 days from the date of the contact, October 8th. Covered California does not have the authority to terminate with less than 14 days’ notice if the result is not the end of the month termination.
    • September 1st to request termination of coverage.  The enrollee wants his/her coverage to be terminated on September 15th, which meets the 14-day advance notice requirement.  The regulations provide that the enrollee is only required to give a 14-day advance notice, even if this results in a mid-month termination date.  Before proceeding, the SCR should explain the implications of a mid-month termination as explained above and recommend the September 30th termination date.  If the enrollee insists on September 15th termination date, however, the SCR should process the termination as requested.
    • May 1st to request termination of coverage on May 10th.  This request for a termination date with less than 14 days advance notice results in a mid-month termination. Explain to the enrollee that Covered California does not have the authority to waive the 14-day noticing requirement unless the effective termination date is the last day of the month. So the earliest termination date allowed would be May 15th, although that is not recommended due to the above reasons.  Explain the termination policies including that only the carrier can approve less than 14-day, mid-month termination requests and that the enrollee would need to contact his/her carrier for approval if he/she still wants May 10th termination but the SCR can terminate the coverage either on May 15th or May 31st, which is the recommended termination date.  Email dated (01/24/2017 09:43 AM)

See Obama Care on Mandatory Summary of Benefits    

 

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6 comments on “30 Day Free Look – Right to view EOC

  1. The law says to return the policy.

    They never sent one. I didn’t get any. They play a game that they sent it. I can’t review it. Its been 21 days. They say I will now get a refund less 150.

    That is not the same position I was in when I started.

    Why do you publish the 1962 law.

  2. I’m curious, paid for Cobra on for May on 6/30 and was told I cannot get a refund because its past 7 days. There was a holiday and the weekend, so I called today 7/8 twice to speak with a supervisor and was told “They didn’t have one available” .

    Is there not a 30 day free look period?

    Thank you

    • First off, I don’t believe in phone calls.
      2nd did you replace your coverage?
      3rd How about getting an individual plan with us. Get quotes here.
      4th The free look from my reading and you’re welcome to check with legal counsel says it’s only for INDIVIDUAL plans. COBRA and Cal COBRA are group plans, as best I can determine.
      Do you have a copy of your Evidence of Coverage?
      When did you receive your policy?
      Why did it take so long for you to pay your May premium?

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