On-Exchange SEP Effective Date Problem

Feb 7, 2016

  1. jefflange
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    jefflange Expert

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    Had a problem enrolling a client through the marketplace yesterday who is loosing Medicaid on 2-29-2016 due to income.

    We completed his application but when I got to the screen to indicate the qualifying event date 2-29-2016 I got an error not letting me put that date.
    The system seemed to indicate I had to use a current date of 2-6-2016 or date before the current date.

    Any suggestion here? I don't want the client to go with out coverage just figured we could get him set up now in a plan for a 3-1-2016 effective date.
     
  2. bluediamond
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    bluediamond Guru

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    Did you put they were losing coverage in the next 60 days? If so I would change the date (because 2/29 is only recognized every 4 years) and use the date you enrolled them, should end up 3/1, but then again could end up 2/7, had that happen once last year. There are a couple different ways to get that 3/1.
     
  3. jefflange
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    jefflange Expert

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    I answered the question that the insured is losing coverage at the end of this month ( Medicaid ) which is effective 2-29-2016.

    I tried to change the date to 2-28-2016 but I still get the following error:

    " Important: Select a date after 10-1-2013 and before today. If the date of your change is in the future, please return as soon as this change occurs to report it "

    It appears through the On-Exchange Public Marketplace you can't enroll until the date your termination occurs or after. This is a problem because the client may have to go without insurance coverage for a period of time depending on what effective date the marketplace-carrier puts him on after we are able to enroll him.
    Off-Exchange I could submit the application today with appropriate SEP verification and get an effective date for 3-1-2016.
     
  4. TN_agent
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    TN_agent Guru

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    Jeff,

    Usually when I am answering it, there are two different questions regarding loss of coverage.

    1. Did you recently lose coverage? (for your client, the answer is no, they still have coverage)

    2. Will you lose coverage in the next 60 days? (the answer is yes).

    For your person, answering the second one yes generates the SEP for the 1st of the month following the loss of coverage. Unless the marketplace has changed their application. Which they have been known to do.
     
  5. jefflange
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    jefflange Expert

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    I do not see both those questions as options. Here are the options I see so far:

    Is ____ currently eligible for health coverage through a Job ? NO

    Will _____ be eligible for health coverage from a job during 2016 ? NO

    Did any of these people recently lose health coverage ? OPTIONAL Yes

    ( this is where I am seeing the problem as it won't take a date in the future. )

    Is there another question that will come up after this asking if the client will lose coverage in the next 60 days ?

    I don't want to answer No to the above question and then there is no follow up question indicating loss of coverage in the next 60 days.

    Thanks again
     
  6. AllenChicago
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    answer no to the question if the person lost insurance in the last 60 days, and the next question will be will this person lose health insurance.
     
  7. jefflange
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    Ok thanks I'll give that a try
     
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