Auto-transition to ACA Plan Does Not Count As SEP?

[dgoldenz]

I was told today by Anthem that being auto-transitioned from a non-grandfather plan to an ACA-compliant plan does not create a SEP for the client, so they can't move to a different company. They also told me no proof of an SEP is required, they're just going to take your word for it. I have a number of clients being auto-transitioned on 4/1 that don't know what to do because they want to keep their plan another two years, but Anthem has not made a determination yet on whether they will allow it. Of course, if they change plans to another company, they will have no option to get their old Anthem plan back, and if they choose another Anthem plan, we don't know whether they will have the option to get it back or not. What a mess...

It seems this should qualify as an "involuntary loss of coverage" but Anthem is telling me that it would not. Anyone else gotten a clear answer from someone who knows what they are doing on whether an SEP is created when someone is auto-transitioned from a non-grandfather plan to an ACA plan?

 

[Yagents]

I know if you go through HC.gov, it would create an SEP. (possible subsidies)
I know if they cancel coverage, they are eligible for Catastrophic plan.
I know these carriers will do/say anything to keep the biz on the books.

No carrier REALLY understands SEP's yet, each are all over the board, and the prez's extensions just make it more confusing, even for carriers/agents.

 

[somarco]

prez's extensions

He got extensions?

 

[dgoldenz]

And now the supervisor tells me the rep I talked to was wrong...they're on the ball

 

[RayNY]

What they consider an SEP, and what other carriers and the exchange will accept as an SEP, may not be the same.

Current plan is no longer available is an SEP. It's "no fault loss of current coverage". The fact that they offer a mapping is irrelevant, current plan is being lost no matter what you do after the fact.

 

[Ann H]

I agree with you, Ray. However, if the carrier automatically enrolls the person in the new ACA plan that they "mapped" them too, I'm worried that that one-time shot at an SEP enrollment has been taken. I'm sure there is recourse, but still it's an issue.

Another issue is the renewal of these pre-ACA plans now that they can keep them longer. If the pre-ACA plan didn't change, or didn't end, then the renewal most likely will not trigger an SEP, because it's not a loss of coverage. I wonder if they will make a new last-minute rule to address this issue. After all, the administration wants as many of those people to move to an ACA plan as they can get.

 

[RayNY]

Ann,

Correct me if I'm wrong:

They're not extending the contract out another year, they are "renewing" into a new contract, with a new effective, at a new rate.

(An extended contract would have a 2-year period, and the same premium the whole time.)

Whether it's automatic, manual, or performed by Zeus, it's still a term+renewal, not an extension of an existing contract, correct?

(For reference, I totally accept your viewpoint, and your concerns are well founded. I just feel it's less likely than the scenario I've outlined above with my personal understanding of the implementation of these requirements.)

 

[Ann H]

RayNY, you probably know more than I do about that subject. I'm pretty sure it's not an extension, like you said, but a renewal. I just don't know if it's a term+renewal. The answers to these questions are going to be extremely important, so thank-you for all your research into these issues.

 

[RayNY]

Thank you as well!

It's amazing this forum is full of professionals like yourself who can have a true discussion on issues as complex as these are. You can't find this anywhere else.

We'll find out who interpreted these rules correctly in a few days, I'm sure official guidance will be released shortly.

Until then, we can all cross our fingers and hope for the best case scenario for our clients: term+renewal (automatic or not) creates an SEP and they have the option to obtain a plan that better meets their needs.