Must Listen--Grace Periods ACA

[Ann H]

Actually, it's not just one carrier. Since this thread started, I have learned that some carriers are using this interpretation of the 90 day grace period, and other carriers are not. From what I understand, the way the 90 day grace period is worded in the actual regulations is the problem.

This should only apply for on-exchange subsidized plans, since they are the only ones given the 90 day grace period in the first place. But who knows. I had one agent tell me that they are experiencing it for both on & off exchange plans!

I am just telling my subsidized clients that I recommend that they pay every premium in full, and that the premium must reach the insurance company before the due date. However, at the very worst, at least once every 3 months they must pay the balance IN FULL, and that payment must reach the insurance company BEFORE the actual due date.

 

[Yagents]

Wow , if I'm reading this document correctly:

https://www.regtap.info/reg_librarye.php?i=449

1. Carriers have to pay out claims for first 30 days, without recourse to providers or the client, for non payment of premiums or claims paid, as the termination date is backdated to day # 30 of the 90 day grace..

2. You must be receiving APTC to have the 90 day grace period. No APTC, only 30 day grace.

3. Technically, you could not pay Oct/Nov/Dec premiums, and re-enroll in new carrier or same carrier for Jan 1st, and get 3 months of insurance for free. See #1 above, and you now also avoid 1% penalty.

Then, if a client wants to really play games. Don't pay (Oct) Nov/Dec, and then go uninsured Jan & Feb, and sign up for Mar 1st effective date, and you've got 4-5 months of free insurance with no 1-2% Ind Resp Penalty.

If you are caught in this predicament with a client, best to choose new carrier in 2015. Now it begs the question, with all the payment/billing/EFT problems, and chances that clients will be moving plans next year, who would want to set up EFT at this point.

Disclaimer: This is for agents information only, if a retail consumer is reading this, do not try this on your own, just ignore what I've written above, as I am not advocating that you "game" the system, plus, your agent can't survive on only 7/12ths of their expected commission.

 

[AllenChicago]

I'm a couple weeks behind in my RegTap.info reading, so thanks for bringing this new information regarding the APTC/90-Day rule to our attention, YAgents.

The people who pay the least for their health insurance get the most generous grace period. Typical illogical government logic.
-ac

 

[houcoogster]

The people who pay the least for their health insurance get the most generous grace period. Typical illogical government logic.
-ac

You should be used to it by now.... living in Chicago and all. It's throwing us Texan's for a loop, you know the rugged individual self-reliant folks that look no further than the end of one's own arm for a helping hand.

 

[Yagents]

It's throwing us Texan's for a loop, you know the rugged individual self-reliant folks that look no further than the end of one's own arm for a helping hand.

So, do you look at the border situation and see 50k illegal entries, 50k new voters, or 50,000 new prospects.

 

[houcoogster]

So, do you look at the border situation and see 50k illegal entries, 50k new voters, or 50,000 new prospects.

I see 50,000 reasons why we need Nationwide"Worksite Enforcement" of our Immigration Laws. Anything else is mere lip service from politicians.

 

[Yagents]

Wow , if I'm reading this document correctly:

https://www.regtap.info/reg_librarye.php?i=449

1. Carriers have to pay out claims for first 30 days, without recourse to providers or the client, for non payment of premiums or claims paid, as the termination date is backdated to day # 30 of the 90 day grace..

2. You must be receiving APTC to have the 90 day grace period. No APTC, only 30 day grace.

3. Technically, you could not pay Oct/Nov/Dec premiums, and re-enroll in new carrier or same carrier for Jan 1st, and get 3 months of insurance for free. See #1 above, and you now also avoid 1% penalty.

Then, if a client wants to really play games. Don't pay (Oct) Nov/Dec, and then go uninsured Jan & Feb, and sign up for Mar 1st effective date, and you've got 4-5 months of free insurance with no 1-2% Ind Resp Penalty.

If you are caught in this predicament with a client, best to choose new carrier in 2015. Now it begs the question, with all the payment/billing/EFT problems, and chances that clients will be moving plans next year, who would want to set up EFT at this point.

Disclaimer: This is for agents information only, if a retail consumer is reading this, do not try this on your own, just ignore what I've written above, as I am not advocating that you "game" the system, plus, your agent can't survive on only 7/12ths of their expected commission.

it seems insurers like to read the forum:

Obamacare loophole has insurers worried customers will skip December premium - Vox

A loophole in Obamacare regulations has health plans worried that people who bought coverage on the federal marketplace could skip their December payment and insurers would have few tools available to recoup that missed premium.

 

[sshafran]

Wow , if I'm reading this document correctly: https://www.regtap.info/reg_librarye.php?i=449 1. Carriers have to pay out claims for first 30 days, without recourse to providers or the client, for non payment of premiums or claims paid, as the termination date is backdated to day # 30 of the 90 day grace.. 2. You must be receiving APTC to have the 90 day grace period. No APTC, only 30 day grace. 3. Technically, you could not pay Oct/Nov/Dec premiums, and re-enroll in new carrier or same carrier for Jan 1st, and get 3 months of insurance for free. See #1 above, and you now also avoid 1% penalty. Then, if a client wants to really play games. Don't pay (Oct) Nov/Dec, and then go uninsured Jan & Feb, and sign up for Mar 1st effective date, and you've got 4-5 months of free insurance with no 1-2% Ind Resp Penalty. If you are caught in this predicament with a client, best to choose new carrier in 2015. Now it begs the question, with all the payment/billing/EFT problems, and chances that clients will be moving plans next year, who would want to set up EFT at this point. Disclaimer: This is for agents information only, if a retail consumer is reading this, do not try this on your own, just ignore what I've written above, as I am not advocating that you "game" the system, plus, your agent can't survive on only 7/12ths of their expected commission.

Genius.

Obama is "graciously" allowing me to keep my plan until 9/30/2017. Then his stupid law cancels my insurance.

But THIS looks like a fantastic idea...


(Said mostly tongue-in-cheek...)

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