Convergence and Capstone
Questions 34 through 41

I. The Defective Instrument

On December 26, 2025, UC representative “Robin” of the UC Retirement Administration Service Center (RASC) directed the undersigned and his spouse, Silvia Z. Harold, to execute UBEN 100 (R10/21) and UBEN 101 (R10/20) forms to disenroll from UC High Option Supplement to Medicare and enroll in Via Benefits. Robin stated this transfer was mandatory for out-of-state retirees. The undersigned complied based on Robin’s representation in her official capacity as a UC benefits representative — the same capacity to which UC’s own UBEN 100 form directs all retirees seeking enrollment assistance (RASC: 800-888-8267). The undersigned’s spouse was present on the call and is available as a witness to Robin’s statements. A spoliation preservation notice has been served on UC requiring retention of all RASC call recordings from December 26, 2025.

The form Robin provided — UBEN 100 (R10/21) — was not the current form. UC had already created and was implementing UBEN 100 (R1/26), a materially revised version containing updated plan options (HealthSavings+), revised submission procedures (UCRAYS as preferred method), new family member verification processes (UnifyHR), and restructured arbitration provisions specifically naming UC High Option Supplement to Medicare. These are not cosmetic changes. They are substantive revisions to the terms, conditions, and legal obligations governing the enrollment transaction Robin directed the undersigned to execute.

The undersigned reasonably relied on UC’s authorized representative to provide the correct instrument. The undersigned’s UC High Option Supplement to Medicare coverage — a federally guaranteed renewable Medigap plan under 42 U.S.C. § 1395ss — was terminated on the basis of this superseded form.

II. The False Statement

Robin’s statement that Via Benefits enrollment was mandatory for out-of-state retirees is contradicted by UC’s own published plan documents. UBEN 100 footnote 4 states the sole restriction on UC High Option Supplement to Medicare: “All covered members must be enrolled in Medicare.” No geographic restriction appears in footnote 4 or anywhere else on the UBEN 100 form. No geographic restriction appears in UC’s Group Insurance Regulations, Part IV, Section 6002. No geographic restriction appears in any UC plan booklet, eligibility fact sheet, or published policy document identified through a comprehensive review of UCnet.

Robin’s analogy at the time of the call — that the transfer to Via Benefits was merely administrative, comparable to Blue Cross California routing claims through Blue Cross Arizona for out-of-state members — was materially misleading. Via Benefits is not a claims-routing mechanism. Via Benefits is a separate program administered by Willis Towers Watson that provides a Health Reimbursement Arrangement (HRA) stipend for retirees to purchase individual Medicare Advantage (Part C) or Part D plans on the private market. As confirmed by Via Benefits representative Joshua Lewis on February 2, 2026, Via Benefits does not offer Medigap/Medicare Supplement coverage. Via Benefits cannot serve as a substitute for UC High Option Supplement to Medicare because it does not offer the same category of insurance product.

The undersigned and his spouse have resided in Arizona continuously since January 17, 2018 — over eight years. This address appears on federal and state tax returns, Anthem Blue Cross enrollment forms, UC pension auto-deposit records at Unify Financial Credit Union (an Arizona credit union), every UBEN 100 form filed by the undersigned, and UC’s own UCRP records throughout this period. UC has mailed pension statements, tax documents, benefits correspondence, and 1099-R forms to this Arizona address for eight consecutive years. Any assertion by UC that the undersigned’s Arizona residence constitutes fraudulent address reporting is contradicted by UC’s own records across eight years of pension deposits, insurance filings, and tax reporting to that same address — and any such assertion would itself constitute a false claim.

III. The Refusal to Enroll and the Coverage Gap

The undersigned and his spouse refused to enroll in Via Benefits upon discovering that Via Benefits does not offer Medigap coverage. The undersigned’s UC High Option coverage was nonetheless terminated by UC. As a direct result, the undersigned and his spouse were left without any supplemental Medicare coverage — exposed to bare Original Medicare with no Medigap protection — for a period of time, through no act or omission of their own. UC created the coverage gap by terminating their existing plan based on a defective instrument and a false statement, and the undersigned refused to accept a replacement program that does not provide equivalent coverage.

The undersigned filed a corrective UBEN 100 (R10/21) on February 13, 2026, faxed to UCRP, RASC, UCRAYS, and UCOP. The Comments section stated: “UC Rep ROBIN incorrectly stated we were required to enroll in VIA BENEFITS which changed out our UC High Option Plan against our wishes and statute. We are keeping our current UC High Option coverage.” The UBEN 101 filed the same date identified the disenrollment from Via Benefits as an “Incorrect Enrollment — Not Required by Code.” Both the undersigned and his spouse signed both forms. UC did not process this corrective filing.

On February 27, 2026, without speaking to Harold about his case and without asking him any verifying questions, Benefits Analyst III Beverly Jeanine Williams-Cook issued a written denial of re-enrollment. Williams-Cook was assigned to Harold’s case on January 30, 2026. She placed one phone call to Harold on February 11, 2026, during which Harold informed her of the evidence supporting his position and his upcoming cancer surgery scheduled for February 25, 2026. She said she would call back after the surgery. She never called back. She never requested a single document. She dated the denial two days after Harold’s radical prostatectomy, while he was in active post-surgical recovery. She never addressed any of Harold’s six prior RASC filings. The denial letter contained an incomplete phone number (800-888-826 instead of 800-888-8267, missing the final digit). Williams-Cook did not mail the letter until late March 2026. The undersigned received the letter in his locked and secure U.S. mailbox on Saturday, March 28, 2026 — 29 days after the date on the letter. No mail is delivered on Sundays at the undersigned’s residence.

Five days after receiving the Williams-Cook denial, the undersigned filed the correct current UBEN 100 (R1/26) on April 3, 2026, stating in the Comments section: “Re-enrollment follows UC’s unilateral cancellation of coverage without notice or consent. See attached cover letter. CALIFORNIA DEPT. MANAGED HEALTH CARE — DMHC Case No. 1409109 — CMS CASE NO. 7100158.” The undersigned attached proof of involuntary loss of coverage as required by the R1/26 form’s “Involuntary loss of coverage” checkbox: the Anthem Blue Cross certificate of coverage termination effective April 1, 2026, which Anthem issued with no prior warning to the undersigned. UC coverage was reinstated April 7, 2026 — but only after intervention by the California Department of Managed Health Care and the Centers for Medicare & Medicaid Services.

IV. The Cognitive Impossibility

UC’s own current UBEN 100 (R1/26) form contains the word “Voluntary” as a checkbox option in the CANCEL/DE-ENROLL section. The superseded UBEN 100 (R10/21) form that Robin provided does not contain this word in the same context.

This creates a logical impossibility that the undersigned respectfully asks Ms. Morse to reconcile:

In December 2025, Robin told the undersigned that enrollment in Via Benefits was mandatory — not voluntary. The undersigned executed the action on the R10/21 form, which did not contain the word “Voluntary” and therefore did not alert the undersigned that the transaction was in fact elective. UC accepted and processed this form without question. UC treated the disenrollment from UC High Option as valid and final.

In February and April 2026, the undersigned filed corrective forms — including the R1/26 form that does contain the word “Voluntary” — to voluntarily disenroll from Via Benefits and voluntarily re-enroll in UC High Option. UC refused to process these forms. Williams-Cook denied the re-enrollment on February 27, 2026.

Had Robin provided the correct R1/26 form in December 2025, the word “Voluntary” would have appeared on the form at the point of execution. A reasonable person — upon seeing that the form characterized the transaction as voluntary while the UC representative characterized it as mandatory — would have questioned the discrepancy. The outdated form concealed the voluntary nature of the transaction. The current form would have revealed it.

V. The Legal Framework — UC Has No Authority to Refuse Re-Enrollment

The undersigned has conducted a comprehensive review of every applicable federal statute, California statute, and UC internal regulation governing the termination and re-enrollment of retiree Medigap coverage. No legal authority exists for UC’s refusal to process the undersigned’s re-enrollment. The following analysis proceeds from the highest authority (federal statute) to the most specific (UC’s own Group Insurance Regulations).

A. Federal Law — 42 U.S.C. § 1395ss(q)(1)(B)

The federal guaranteed-renewability statute is unambiguous. Section (q)(1)(B) states that the issuer “shall not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation.” The phrase “for any reason other than” creates a closed, exhaustive list. Congress limited permissible Medigap cancellation to exactly two grounds: (1) nonpayment of premium by the policyholder, and (2) material misrepresentation by the insured — meaning fraud in the application.

The undersigned did not commit fraud. The undersigned did not fail to pay premiums — UC unilaterally stopped deducting premiums from the undersigned’s UCRP pension in February 2026, without notice, in the same month Williams-Cook issued her denial. UC manufactured the non-payment by ceasing to collect the premium it was obligated to deduct. Under § 1395ss(q)(1)(B), UC had no permissible ground to cancel the undersigned’s coverage.

The undersigned and his spouse have resided at [address withheld], Apache Junction, Arizona 85119 continuously since January 17, 2018. This address has been reported to UC on every pension document, every UBEN form, every tax filing, and every insurance enrollment form for over eight years. UC has auto-deposited pension payments to the undersigned’s Unify Financial Credit Union account — an Arizona credit union — throughout this period. Anthem Blue Cross has processed claims and mailed correspondence to this address throughout this period. Any characterization of the undersigned’s Arizona residence as a basis for “material misrepresentation” under § 1395ss(q)(1)(B) is not only unsupported by the evidence — it is contradicted by UC’s own eight years of records reflecting and accepting that same address, and any such assertion would itself constitute a false claim.

Violations of guaranteed-renewability requirements carry civil penalties of up to $25,000 per violation under § 1395ss(p)(8).

B. California Law — Insurance Code § 10192.81(a)(5)(B)

California’s state-law counterpart tracks the federal language: “The issuer shall not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation which is shown by the issuer to be material to the acceptance for coverage.” California places the burden of proof on the issuer to demonstrate that any alleged misrepresentation was material to acceptance — subject to a two-year contestability period under Insurance Code § 10350.2. Filing corrective enrollment forms does not constitute material misrepresentation at acceptance. Out-of-state residence does not constitute material misrepresentation at acceptance.

California Insurance Code § 10192.12 separately establishes guaranteed issue rights for individuals who lose Medicare supplement coverage involuntarily, including when an employer welfare plan terminates supplemental benefits (§ 10192.12(b)(1)) or when the issuer commits a material violation of the policy (§ 10192.12(b)(5)).

C. UC Group Insurance Regulations — No Applicable Ground Exists

UC’s own GIRs, Part IV, Section 6002 (Medical and Dental Plans), effective February 2026, enumerate the exclusive grounds for disenrollment of retirees. The undersigned has reviewed every applicable provision. None authorize termination or denial of re-enrollment based on administrator error, a UC representative’s false statement, use of a superseded form, the filing of corrective enrollment forms, or out-of-state residence.

The GIRs permit disenrollment only in these enumerated circumstances: unpaid premiums, with coverage lapsing retroactively to the first month for which premium was missed (§ 6008.A); death or loss of eligibility for monthly UCRP payment (§ 6008.C); eligibility for UC employee health coverage (§ 6008.D–E); failure to enroll in or maintain Medicare Parts B and D after a cure period (§ 6008.F–G); ineligibility for specific enumerated reasons including duplicate coverage or pre-2005 voluntary cancellation (§ 6004.B.1); failure to provide family member eligibility verification documents (§ 6004.B.3); and misuse of the plan defined as falsifying enrollment/claims information, enrolling ineligible individuals, or allowing others to use the member’s ID card (§ 6004.B.4).

None of these apply to the undersigned. The undersigned did not fail to pay premiums — UC stopped collecting them. The undersigned did not die or lose UCRP eligibility. The undersigned is not eligible for UC employee coverage. The undersigned maintained Medicare Parts A and B throughout. The undersigned did not voluntarily cancel prior to January 1, 2005. The undersigned did not misuse the plan.

D. The GIRs Affirmatively Require Re-Enrollment

Not only do the GIRs fail to authorize UC’s refusal — they affirmatively require UC to process re-enrollment under the facts of this case.

GIR § 6003.C.1 establishes a new 31-day Period of Initial Eligibility (PIE) beginning the day after prior coverage ends, triggered by “Involuntary Loss of Coverage” (ILOC). Qualifying ILOC events include loss of employer group coverage due to “termination of employer contributions towards health coverage” (§ 6003.C.1.b). UC’s unilateral cessation of premium deductions from the undersigned’s pension constitutes termination of employer contributions toward health coverage. The GIRs explicitly exclude from ILOC only two scenarios: “failure to pay premiums on a timely basis” and termination “for cause (such as making a fraudulent claim or intentionally misrepresenting a material fact).” Neither applies.

GIR § 6004.A.2 provides additional re-enrollment pathways: during any applicable PIE including ILOC (§ 6004.A.2.a); during the annual Open Enrollment Period (§ 6004.A.2.b); and at any time, subject to a 90-calendar-day waiting period (§ 6004.A.2.c).

The UBEN 100 (R1/26) form itself includes a specific checkbox under the ENROLL section for “Involuntary loss of coverage” with a field for the loss-of-coverage date and a requirement to attach proof. UC’s own form — the correct, current form — anticipates and provides for exactly this situation. The undersigned provided UC with the Anthem Blue Cross certificate of coverage termination effective April 1, 2026, issued by Anthem with no prior warning to the undersigned, as proof of involuntary loss of coverage with the April 3, 2026 UBEN 100 (R1/26) filing.

E. The Contract Law Foundation — The December 2025 Action Is Voidable

Under California Civil Code § 1577, a contract is voidable when one party’s mistake concerns a basic assumption, has a material effect on the exchange, and the other party’s fault caused the mistake. UC’s representative provided the outdated form — UC caused the mistake. The undersigned reasonably relied on UC’s authorized representative to provide the correct instrument.

Under California Civil Code § 1573, constructive fraud is “any breach of duty which, without an actually fraudulent intent, gains an advantage to the person in fault... by misleading another to his prejudice.” Robin breached her duty as UC’s designated benefits representative by providing incorrect information and a superseded form, and this misled the undersigned to his prejudice — the loss of guaranteed renewable Medigap coverage.

Under California Civil Code § 1572, actual fraud includes “the suggestion, as a fact, of that which is not true, by one who does not believe it to be true” and “a promise made without any intention of performing it.” Robin’s statement that Via Benefits enrollment was mandatory for out-of-state retirees constitutes a positive assertion of a material fact — mandatory enrollment — that is contradicted by UC’s own plan documents, which impose no geographic restriction on UC High Option eligibility.

The undersigned’s corrective filings of February 13, 2026 and April 3, 2026 constitute rescission under California Civil Code § 1689(b)(1), not ratification. Ratification requires voluntary affirmance with full knowledge of all material facts (Cal. Civ. Code § 1588). Filing forms to undo an action taken under false pretenses is the opposite of affirmance.

VI. Formal Demands

The undersigned makes the following demands of the University of California, to be answered in writing within a reasonable time:

VII. The Undersigned’s Position

A reasonable and prudent person, when confronted with these and the other undisputed facts documented in Questions 1 through 40 above, would reach the conclusion that a series of actions by the University of California have severely damaged the undersigned’s medical insurance coverage and thereby directly endangered the health and welfare of the undersigned and his spouse. The undersigned respectfully directs the attention of Benefits/Insurance Supervisor Erin Morse to the totality of these facts and encourages a good-faith resolution consistent with the University’s legal obligations under federal and state law and UC’s own Group Insurance Regulations.

It is not lost on the undersigned that the up-to-90-day period to review his grievance, as stated in Ms. Morse’s April 9, 2026 letter, will run past his legal ability to obtain Medigap insurance without possible future denial or cost-prohibitive medical underwriting for pre-existing conditions. The undersigned has seen this tactic before. In 1996, when Harold was placed on paid medical leave due to an on-duty injury (Harold was injured in a physical altercation while on duty and in uniform, was transported to UCLA Medical Center for treatment, and was placed on medical leave by UCLA’s own physician), Chief Karl T. Ross — a named defendant in Harold v. Regents of the University of California, Case No. SC022125 — informed Harold that since the police department had up to 120 days to decide whether Harold’s claim was valid, he would not be receiving any money until then. That delay caused the loss of Harold’s home refinance loan, extreme financial hardship, a drive-by shooting at his home, and the stress-related loss of their third otherwise healthy child by miscarriage. The undersigned will not be subjected to the same institutional delay tactic thirty years later.

The undersigned will not be fooled again and will not await the conclusion of any 90-day administrative review period to secure medical coverage and protect the health and welfare of himself and his wife. The undersigned will act independently, at the time, place, and through the mechanism of his choosing, to preserve and enforce his rights under 42 U.S.C. § 1395ss, California Insurance Code § 10192.81, the UC Group Insurance Regulations, and all other applicable federal, state, and contractual authorities. The undersigned has been engaged in law enforcement, investigations, and security consulting for 43 years and recognizes the factual indicators documented herein.