A Special Enrollment Period Will Allow a Consumer to Enroll

[AllenChicago]

August 20, 2014

FYI, Health Care Services Corporation (HCSC) has published an updated Special Enrollment Period guide that takes into account some new guidance recently received from HHS/CMS.

For those who care, a copy of it is attached to this post in .pdf format. Seems to be several new sub-categories..24 pages in all.

-ac

 

[houcoogster]

Thanks for posting AC...do you offer a free explanation.... by chance?

 

[tonyisme]

That "misconduct by the agent " sounds like a opportunity to blame an agent

 

[RayNY]

The alleged "misconduct" must result in the broker
1) Failing to enroll the consumer.
2) Enrolling the consumer in the wrong plan.
3) Not getting APTC's for an eligible client.

IMO, if that's the screw up an agent made, they deserve some blame, because that's a real screw up. This is why we require all changes in writing and file everything, our butts are covered if they try to throw us under the bus.

 

[houcoogster]

The alleged "misconduct" must result in the broker
1) Failing to enroll the consumer.
2) Enrolling the consumer in the wrong plan.
3) Not getting APTC's for an eligible client.

IMO, if that's the screw up an agent made, they deserve some blame, because that's a real screw up. This is why we require all changes in writing and file everything, our butts are covered if they try to throw us under the bus.

How much you wanna bet 99.9% of the complaints will be from people in an HMO that want to switch to a PPO due to a NEW health condition?

 

[dgoldenz]

Anyone know if the rules were ever changed to allow SEP during a group's OEP? Have a client with OEP in October that wants to change to individual.

 

[AllenChicago]

How much you wanna bet 99.9% of the complaints will be from people in an HMO that want to switch to a PPO due to a NEW health condition?

I had one client in that situation this past June. His primary doctor and nearest hospital were in the HMO network, but the operation he needed could only be done at a Chicago hospital that was not in the HMO network. He got the operation, but the hospital/surgeon bill remains unpaid while an appeal process grinds along.

 

[RayNY]

How much you wanna bet 99.9% of the complaints will be from people in an HMO that want to switch to a PPO due to a NEW health condition?

You're probably right on that one. I've had a LOT of clients want to switch plans/networks/carriers due to network inadequacy. I helped who I could, explained the situation to the others.

I guarantee one or two will complain, and probably escalate it as high as they have to to get what they want. As long as I did everything right and their issue is dissatisfaction with the carrier or law, it's not my butt on the line, it's not a problem I'm capable of solving, and it's not something that's going to keep me up at night.

 

[AllenChicago]

January 19, 2016

Beginning February 1, 2016, Special Enrollment options will be a tad fewer in number...

"Eliminating Unnecessary Special Enrollment Periods: Last month, we announced that the Tax Season special enrollment period will no longer be offered. Today we are announcing the elimination of six other special enrollment periods that are no longer needed. Just as the Marketplace evolves, so too does consumer behavior. The rules we use to operate the Marketplace need to keep up with these changes. As such, special enrollment periods are no longer available for: Consumers who enrolled with too much in advance payments of the premium tax credit because of a redundant or duplicate policy
Consumers who were affected by an error in the treatment of Social Security Income for tax dependents
Lawfully present non-citizens that were affected by a system error in determination of their advance payments of the premium tax credit
Lawfully present non-citizens with incomes below 100% FPL who experienced certain processing delays
Consumers who were eligible for or enrolled in COBRA and not sufficiently informed about their coverage options
Consumers who were previously enrolled in the Pre-Existing Condition Health Insurance Program"

For additional clarifications and info, see today's CMS blog at:
Clarifying, Eliminating and Enforcing Special Enrollment Periods | The CMS Blog

From Bloomberg: http://www.bloomberg.com/news/artic...re-sign-up-periods-in-move-to-please-insurers

 

[russelltw]

Now that will really show those who are abusing SEPs whose boss..

Yet I have never seen most of these SEPs.

Hey CMS, how about you monitor your own personnel in the call centers. I sent 5 people to the marketplace, in each case, there was no QLE to get an SEP. I told each one that I could not help, but they could call the marketplace and see what happens. Each one called the marketplace and amazingly got enrolled the first of next month...

I have to follow the law, hc.gov employees not so much...