A Special Enrollment Period Will Allow a Consumer to Enroll

[cadylou]

I'd advise what's best too, but if I don't get paid he'll have to enroll without me

 

[yorkriver1]

I sense that most, if not all carriers will follow suit in limiting SEP commissions. What agent wouldn't be looking around for those who will still pay?

 

[Sherota1]

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: U.S. Limits Obamacare Sign-Up Periods in Move to Please Insurers - Bloomberg Business

It's been replaced with this. More reasons no one has to follow the rules. Oh that's right there are not any.

CMS Issues Guidance Establishing*A New SEP

 

[AllenChicago]

Feb 19, 2016

If a person didn't get a bill for their auto-renewed 2016 plan, and their 2015 plan ended on 12/31/2015, they have a 60-day SEP opportunity (until 3/1/2016), and the new plan will/must be effective retroactive to 1/1/2016. RIGHT?

 

[kgmom219]

Feb 19, 2016

If a person didn't get a bill for their auto-renewed 2016 plan, and their 2015 plan ended on 12/31/2015, they have a 60-day SEP opportunity (until 3/1/2016), and the new plan will/must be effective retroactive to 1/1/2016. RIGHT?

They have a 60 day SEP. But I would say eff 3/1

 

[AllenChicago]

They have a 60 day SEP. But I would say eff 3/1

I haven't done but a few of these "Loss of Coverage" SEP's, but in each instance, the effective date was made the day after coverage was lost. There was no way to change it. You're saying that this is no longer the rule for 2016 SEP's, KGMom? If so, that would be SUPER!

 

[yorkriver1]

The only official backdated SEP I have seen is for birth or adoption, but this is a new SEP, so it's possible. Bad moral hazard, and adverse selection for prior claims if they do backdate.

Clients with no claims would complain, too. Just had one who got accidentally cancelled by the carrier, because the their CSR spelled client's name wrong on the phoned in bank card payment ACH request. Not happy about paying back for January because there were no claims. After being told that this is the only way to get coverage until next year, then it made sense.

 

[RayNY]

I haven't done but a few of these "Loss of Coverage" SEP's, but in each instance, the effective date was made the day after coverage was lost. There was no way to change it. You're saying that this is no longer the rule for 2016 SEP's, KGMom? If so, that would be SUPER!

https://www.law.cornell.edu/cfr/text/45/155.420

45 CFR 155.420. Don't you have this memorized yet? I know this off the top of my head at this point because it seems like there's always a question on it. FYI, this hasn't changed.

"(iv) In a case where a consumer loses coverage as described in paragraph (d)(1) or (d)(6)(iii) of this section, if the plan selection is made before or on the day of the loss of coverage, the Exchange must ensure that the coverage effective date is on the first day of the month following the loss of coverage. If the plan selection is made after the loss of coverage, the Exchange must ensure that coverage is effective in accordance with paragraph (b)(1) of this section or on the first day of the month following plan selection, at the option of the Exchange;"

So, reported before or on the date of loss=first of month following loss (no gap)

After date of loss= subject to the "15th rule", and it's "at the option of the Exchange", which means they can do whatever they want.

 

[Yagents]

Gaming the system............who woulda thunk that?

What are

Bertko said some issuers have documented hundreds of cases of off-exchange applicants who first were denied coverage due to their not being able or willing to provide valid proof of SEP eligibility, then re-applying for coverage through Covered California and getting SEP coverage.

 

[houcoogster]

Today's WSJ Letter to the editor:


Feb. 22, 2016 5:34 p.m. ET

"Insurers Flag Deepening Losses on Health Law" (page one, Feb. 11) underscores the need for federal policies that stabilize the individual market so it is affordable for everyone. A system in which people can get health insurance regardless of existing conditions can be viable only if people maintain continuous coverage.

The current rules allow people to enter the marketplace through many special enrollment periods without having to prove they are eligible and whether they had prior coverage. This enables people to buy health insurance only when they need medical care and then drop coverage after services are rendered and claims paid. While special enrollment periods are important and necessary, the government should be validating eligibility. Otherwise people will purchase coverage only when they need medical care, driving up costs for everyone.

As we approach the fourth year of the new market, it is critical that the federal rules for 2017 encourage everyone to maintain continuous coverage so premiums are affordable. This is crucial to increasing participation and coverage among healthier individuals, who help balance the overall risk pool and stabilize the market.

Scott Serota

President and CEO

Blue Cross Blue Shield Association

Chicago