How to Change Plans for On Exchange Clients

[AllenChicago]

Thurs 2.27.2014

Talk about local Confusion... Our BCBS-IL MGA tells me on Tuesday that my newly acquired client, who purchased on-exchange (no subsidy) CAN change from the narrow network Bronze, to the wide network Bronze, regardless of where the plan was purchased (on or off exchange) and even if premiums have been paid. The told me not to submit a new application on this guy because it would gum up the works and delay his plan transition, which is still pending, because BCBS-IL is 30 to 45 days behind schedule with its workload. However, his plan change would be effective retroactive to 2/1/2014, since we submitted his request before January 15th. I inform the client, he agrees to wait it out.

BCBS-IL sends out an e-mail to all producers on Wednesday re-affirming that ONLY OFF-EXCHANGE customers can make a plan change...no exceptions. Argh!

I'm just going to recommend to Mr. Smith that we apply for the plan he wants directly at the BCBS-IL website.. list his narrow-network policy as his existing coverage.. and let the chips fall where they may. I don't think this situation can be "gummed up" any more than it is!
ac

 

[Post Quartermaster]

Thurs 2.27.2014


BCBS-IL sends out an e-mail to all producers on Wednesday re-affirming that ONLY OFF-EXCHANGE customers can make a plan change...no exceptions. Argh!

I think cms would disagree.......

 

[AllenChicago]

I think cms would disagree.......

Right On P.Q.!
This wording in the Blue Cross of Illinois e-mail tells me that someone from outside of the state (HCSC HQ?) is drafting the BCBS-IL rules..and is also not interpreting the HHS/CMS directives accurately.

""Policies Purchased Through Get Covered Illinois, the Official Health Marketplace of Illinois:
Individual members who purchased policies through Get Covered Illinois, and have either made their first payment and/or have their policy in effect, may not make changes to their policies at this time.""

1. Illinois DOES NOT HAVE an Official Marketplace! We use Healthcare.gov. Get Covered Illinois was SUPPOSED to be our state-run exchange, but our politicians couldn't agree on anything, so it never was built.

2. Marketplace purchasers CAN make changes to their policy... for the reasons already discussed in this thread.

What a mess! Senator Harry Reid will get his horror stories, courtesy of his beloved ObamaScare legislation. And they'll be far worse than the single death on the George Washington bridge that he's blaming on Governor Christie of NJ.
ac

 

[cadylou]

I have a client that signed on for a Coventry plan thru exchange here & then found out the network was narrow. She cancelled Coventry AFTER paying a premium and wanted to sign on for a new plan thru marketplace (she qualifies for subsidy). They told her she'd have to delete her account & would be able to get on & do a new account to buy the new plan, but every time she calls they say the system is broken and that they cannot do it. Therefore, she is uninsured & will most likely remain that way, since she can't afford insurance without the subsidy. Since much of this happened before she called me, I cannot help her at all. I might have been able to prevent this from happening had I been involved earlier & could have explained the networks to her - but, no such luck. Anyway, they've really left no room for a customer to make a mistake and remedy it. These are people who have no experience with purchasing insurance . . . .how would they know these things? I guess the government doesn't consider these issues since they all have great group coverage, that we all pay for!

 

[Sherota1]

Check out this CMS Bulliten. It's a revision of the rules dated 02-06-14. MD state exchange follows the old rules. If you paid you are stuck. I'm not sure if those who work at the exchange are aware of this. See #5.

 

[Post Quartermaster]

I have a client that signed on for a Coventry plan thru exchange here & then found out the network was narrow. She cancelled Coventry AFTER paying a premium and wanted to sign on for a new plan thru marketplace (she qualifies for subsidy). They told her she'd have to delete her account & would be able to get on & do a new account to buy the new plan, but every time she calls they say the system is broken and that they cannot do it. Therefore, she is uninsured & will most likely remain that way, since she can't afford insurance without the subsidy. Since much of this happened before she called me, I cannot help her at all. I might have been able to prevent this from happening had I been involved earlier & could have explained the networks to her - but, no such luck. Anyway, they've really left no room for a customer to make a mistake and remedy it. These are people who have no experience with purchasing insurance . . . .how would they know these things? I guess the government doesn't consider these issues since they all have great group coverage, that we all pay for!

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