New SEP Enrollment Item?

[Duaine]

Losing Health Coverage:


Below are some situations where losing health coverage may qualify you for a Special Enrollment Period:

•Your employer stops offering coverage
•You leave a job where you had health coverage (even if you left your job by choice)
•Your individual plan is cancelled — meaning the plan no longer exists
•Your individual or job-based health plan is ending for the year and you choose not to renew it (but see note below)

Be careful about dropping coverage

If you voluntarily drop coverage before the plan year ends: You don't qualify for a Special Enrollment Period. You also don't qualify if you lose coverage because you don't pay your premium.

If you don't renew a job-based plan when its plan year ends: You do qualify for a Special Enrollment Period to buy a Marketplace plan. Very important: If the job-based plan you don't renew is considered affordable and meets minimum value, you won't qualify for a premium tax credit that lowers the cost of your plan. Ask your employer to complete the Employer Coverage tool (PDF) to see if your job-based plan meets these requirements.

https://www.healthcare.gov/help/losing-health-coverage/

 

[sman]

Losing Health Coverage: Below are some situations where losing health coverage may qualify you for a Special Enrollment Period: oYour employer stops offering coverage oYou leave a job where you had health coverage (even if you left your job by choice) oYour individual plan is cancelled -- meaning the plan no longer exists oYour individual or job-based health plan is ending for the year and you choose not to renew it (but see note below) Be careful about dropping coverage If you voluntarily drop coverage before the plan year ends: You don't qualify for a Special Enrollment Period. You also don't qualify if you lose coverage because you don't pay your premium. If you don't renew a job-based plan when its plan year ends: You do qualify for a Special Enrollment Period to buy a Marketplace plan. Very important: If the job-based plan you don't renew is considered affordable and meets minimum value, you won't qualify for a premium tax credit that lowers the cost of your plan. Ask your employer to complete the Employer Coverage tool (PDF) to see if your job-based plan meets these requirements. https://www.healthcare.gov/help/losing-health-coverage/

Just did a few enrollments this week using this SEP.

 

[KennyWest]

Make sure as well that if they were offered COBRA that they did NOT ever pay a single COBRA premium. We have seen a few which only told the agent they lost coverage due to job change but failed to tell the agent (or the agent did not ask) that they had paid one or more COBRA premiums.. Pay one and SEP is not a choice...

 

[Yagents]

Just did a few enrollments this week using this SEP.

How did you do them? Online or with HC.gov rep on phone? If online, is there a specific "reason" to select in the life change for this new SEP?

----------

Also, there is a new SEP for those in non medicaid expansion states, where if they were initially under 100% FPL, and now are above it with new income, that they get an SEP. Has anyone done one of these yet? Online? Over the phone?
Did they have to apply and be denied subsides during OEP.....have an account already?

 

[sman]

How did you do them? Online or with HC.gov rep on phone? If online, is there a specific "reason" to select in the life change for this new SEP? ---------- Also, there is a new SEP for those in non medicaid expansion states, where if they were initially under 100% FPL, and now are above it with new income, that they get an SEP. Has anyone done one of these yet? Online? Over the phone? Did they have to apply and be denied subsides during OEP.....have an account already?

Online at hc.gov. The employer's plan is renewing and they switched to a terrible plan so they opted not to re-enroll. I called the Marketplace to confirm that their definition of a plans "year-end" didn't mean December 31st. She had to check with someone and confirmed that the group renewal is considered the year-end. Of course I could call again and get a different answer. That's what scares me when doing this kind of thing.

I'm having the employer write a letter on company letterhead to submit when they ask for documentation of loss of coverage.

 

[kgmom219]

Online at hc.gov. The employer's plan is renewing and they switched to a terrible plan so they opted not to re-enroll. I called the Marketplace to confirm that their definition of a plans "year-end" didn't mean December 31st. She had to check with someone and confirmed that the group renewal is considered the year-end. Of course I could call again and get a different answer. That's what scares me when doing this kind of thing.

I'm having the employer write a letter on company letterhead to submit when they ask for documentation of loss of coverage.

Don't worry...there was a Regtap (or maybe CMS) email on this recently. Its an SEP. Even if the reps don't know about it.

 

[sman]

Don't worry...there was a Regtap (or maybe CMS) email on this recently. Its an SEP. Even if the reps don't know about it.

I know it is, but that doesn't mean the person making the final decision on their case will understand this.

 

[kgmom219]

I know it is, but that doesn't mean the person making the final decision on their case will understand this.

I've had to give the Regtap number to the rep, but I havent had it turned down.

 

[JosephDeacon]

When did this new SEP item become an option?

 

[JosephDeacon]

Can someone confirm that this SEP ONLY applies to employer sponsored coverage?

I have had several renewals on UHO policies that have been somewhat high and people are not happy.

If you don't renew a job-based plan when its plan year ends: You do qualify for a Special Enrollment Period to buy a Marketplace plan. Very important: If the job-based plan you don't renew is considered affordable and meets minimum value, you won't qualify for a premium tax credit that lowers the cost of your plan. Ask your employer to complete the Employer Coverage tool (PDF) to see if your job-based plan meets these requirements.