SEP Enrollment Effective Date Question

Discussion in 'Health Care Reform Forum' started by jefflange, Aug 23, 2017.

  1. jefflange
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    jefflange Expert

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    Long story short:
    Have a client who is losing their COBRA coverage on 9-12-2017.
    Basically they have exhausted their 18 months.
    We are trying to get an effective date form the insurer's in my state-territory in Ohio to cover them effective 9-12-2107.

    The result is that each insurer will only issue a 10-1-2017 effective date.
    First of month following Loss of Coverage date, so no mid month effective dates allowed anymore.

    Also they could not ask for a 9-1-2017 due to the fact their current plan has not cancelled yet.

    Does this sound correct ?

    Usually I see my SEP's & coverage loss dates at the end of the month not mid month.

    I have a hard time believing out politicians would put responsible minded consumers in a position where they would have a GAP in their coverage at no fault of their own.:skeptical:

    Yes I did explain and offer STMM, but that would not solve the possible exposure that could happen in the event of a pre-existing condition.
     
  2. Yagents
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    Yagents Guru

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    Everything you posted is correct.
    STM is the only viable option.
    Politicians have no clue of the real world.
    Maybe an off exchange carrier will entertain a mid month enrollment.
    They do it for births, so it can be done.
     
  3. jefflange
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    jefflange Expert

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    I checked with all the insurer's I represent in my area. This does not include Ambetter or CareSource as I am not able to offer their coverage.

    It appears that unless its a Child Birth or Court Ordered the insurer's will not issue a mid month effective date any longer.

    We had a local regional insurer that use too but they now have changed and no longer offer mid month dates per CMS Guidelines.

    Really sucks. It just leaves Gaps in coverage for consumers who do everything by the rules.

    I also contacted the Marketplace yesterday, called the agent help line and they just forwarded me to the Marketplace.
    Was advised a 10-1-2017 effective date was the only available option since their Employer Sponsored Health coverage (COBRA ) ends on 9-12-2017.

    Time for CMS and Insurer's to only use End of Month termination dates on everything.
     
  4. LostDollar
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    I would like to see documentation from the former employer indicating group insurance coverage actually ended mid month. In my experience employers have to pay for coverage by the month and will deduct the premiums for the "after termination" portion of the employee's final month from their final pay.

    Any adjustments between ins carrier and employer are for whole month premiums, not part month premiums.

    It would be an easy administrative error for a clerk to enter an employee's last work day, rather than the actual end of insurance day, in cobra records. Not saying your situation could not happen, but I would verify that it really did. (And rules may be different in other states too.)
     
  5. jefflange
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    I can tell you I have the COBRA termination letter, as it is required for proof of the SEP Qualification which needs to be submitted with the clients application.
    The COBRA Termination letter clearly states the date coverage will end for this individual and his spouse is 9-12-2017.
     
  6. Yagents
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    Yagents Guru

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    Once again, sticking your nose where it doesn't belong (not being an agent).

    Hundreds of my clients were on Cobra, about 10% of them had a mid month cancellation. Some employers term coverage the day you are fired/leave.
     
  7. FLM2
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    Don't waste your time with the no-nothing wannabe expert, next thing he will do is find 20 links to post in support of his incorrect guess.

    Even a broken clock is right more often than him...
     
  8. scagnt83
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    Totally wrong. It happens all the time. Most Plan Documents base it on pay-period.
     
  9. LostDollar
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    LostDollar Guru

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    I said in my experience, which is:
    40 years.
    5 employers (in Kansas).
    > 1,000 employees (active and term).
    At an estimate, 300-400 termed emps.

    Obviously some of you have different experience.

    (And in regard to "accepting" Cobra docs w/o question: my current 3rd party cobra administrator has totally deleted me from their computer system twice.)
     
    Last edited: Aug 23, 2017
  10. kgmom219
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    kgmom219 Guru

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    Its too late now, but why wouldn't you sign them up for a 9/1?

    And yes, I've done it via Sherpa.
     
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