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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    How would I go about signing him up for a 9-1-2017 effective date?
    His current COBRA is still active until 9-12-2017 and therefor he is not eligible for an SEP enrollment until the date of loss which is 9-12-2017.

    HHS Guidelines for SEP for loss of Cobra benefits states:

    Coverage Effective Dates

    If a plan selected before loss : 1st day of the month following loss of previous coverage.

    If a plan selected after Loss : 1st day of month following plan selection.


    Basically he is not eligible for an SEP Enrollment until his Loss date on 9-12-2017.

    Am I missing something here?

    All 4 of the insurer's I contacted have stated because his loss occurs on 9-12-2017 the earliest effective date the client can get is the 1st of the month following the loss which would be 10-1-2017. Loss of coverage is on 9-12-2017. They also indicated they do not do mid month effective dates unless its a child birth or court ordered.

    Not sure how Sherpa can skirt this and give him an effective date prior to his current plan loss date.
     
  2. kgmom219
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    I gave up trying to figure out the "whys", especially after the June FFM upgrade. Its moot point now, but if you did it before 8/15, I am 99.9% certain it would work for a 9/1. Sherp goes direct to the FFM right now, its not a Sherp issue. But I could be wrong...its happens once in a while. ;)
     
  3. DS4
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    I don't blame them. You probably call 5 times a day with dumb questions
     
  4. jefflange
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    Not according to my insurers. The trigger of the SEP is the date of loss. In this case 9-12-2017. They would not be eligible for a SEP Enrollment on 9-1-2017 as their Cobra Coverage is still in effect. You can't voluntarily cancel or not pay your premium under cobra and qualify for a SEP enrollment.
    You can enroll up to 60 days before loss of coverage ( Advance Availability ) but the effective date will be 1st day of month FOLLOWING Loss of previous coverage.

    That's my understanding of this anyway and the way it was explained to me by not 1 but 4 of my insurer's.
     
  5. TN_agent
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    Jefflange,

    It is the same here. There is a gap when the last day of work = the last day of active coverage, that has been explained to me many times and there is not a way around it with the current system. I have not been able to write an effective date prior to the COBRA termination date yet. Yet another gap/glitch in the way they wrote the law.

    I write my clients short term if I can for the gap (if they can pass underwriting). If they can't, I counsel them to be really careful and take their insulin/blood pressure medicine without fail for the rest of the month.
     
  6. jefflange
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    Yes I did the same, I provided them with STMM Quotes and explained the Pre-Existing Condition Clause & potential exposure. Not sure if they will opt the STMM but it has been proposed & recommended to help limit possible exposure during the 18 days needed.

    This type of exposure issue needs to be fixed and either allow mid month effective dates for various cases or mandate employer coverage terminations last day of month.
     
  7. junkman
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    OP, yes, there is a gap. Sometimes you can slide the app through. Alternatively, write a STM.

    Lost, you are incorrect. Coverage ends mid-month if the contract says that it does. Experience with 5 employers is not much. Perhaps akin to the same 1 year of experience 40 times. Learn to take in new information.
     
  8. LostDollar
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    My post was an attempt to apply a basic insurance problem solving approach which P&C agents seem to use all the time. Apparently it is of no interest to health agents.
     
  9. GreenSky
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    Seems to be a common theme in your posts.

    Rick
     
  10. junkman
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    That's no excuse for shooting off your mouth and giving incorrect information. Your conclusions were/are incorrect and irrelevant. Work for an employer in an official capacity and give incorrect advice say to someone that is SEP eligible and the employer may be held responsible when the employee has a claim but is not enrolled because they acted on your advice.

    My P&C agent's service person gives incorrect information frequently and goes on "common sense" apparently because she doesn't read the contract or confirm with the carrier. I have her email me confirmation on anything she says. That way I'll have the agent's E&O on the hook if something goes really wrong. I would prefer that she give correct information.

    That seems to be an industry wide approach. I gave a car to a friend of mine. I referred the business to 1 agent. He got partial information, gave a quote, took a binder check then in the 2nd month wanted much more money because the driver hadn't had coverage in effect and rates came back higher than quoted. His next step was to quit returning calls to me or the client. She eventually got her money back and went elsewhere. The 2nd agent did similar. Both agents had been in business for a long time. Apparently, there is enough rewriting of contracts that the agent can be incompetent and survive with a "get the check" approach.

    I tell my 15 yr old that making mistakes is a way to learn. I expect that you're over 15. Hopefully, you'll learn and quit giving incorrect advice on a technical subject.
     
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