Special Enrollment Can't Buy Coverage

[junkman]

It "looks like" she's enrolled. I'll find out tomorrow. Now I just need to get through the payment hoop. Apparently need to get the insured an account set up at BC so they can draft a payment. I'm sure she will be happy to implement using her phone on the BC site.

Like I said, I'll only do this for friends. What a cluster ....headache.

 

[TxOnline]

I quit submitting SEP's in late October, when the FFM folks told me their guidelines....as I indicated above.
I'm glad to know that's not correct!

I've sold them STM's (since late October) to cover them TO Jan 1st.

The last app that I submitted in late October.....for an SEP....with Group Employer coverage ending on 10/31....got an effective date of Dec 1st...at HC.gov.
I called them several times to correct the effective date (to Nov 1st)...to no avail. Quit trying after that.

This was NOT the 1st time that the SEP effective date was extended like that (for me). I even remember discussing it on another thread in October...about an app that I submitted in early October. Covg ended Sept 30th. They got an effective date of November 1st (in that particular case).

Thank you for the confirmations that it works correctly, PQ & Ann!

I might NEED to try it again (if client can't qualify for STM).

 

[junkman]

The last part of the process involves paying the premium. Healthcare.gov sends the applicant to the carrier site - Blue Cross in this case. Of course, Blue Cross doesn't yet have a record of the application and payment can't be set up yet.

Blue Cross recommended waiting a few days and checking back or calling in to set up a draft.

 

[timsip]

Perhaps, perhaps not. Please provide your reasoning.
She has a qualifying event and is processing before the effective date. The written documentation that I've seen says she has 60 days from a qualifying event in which to apply. I haven't seen effective dates noted for a given application date other than for open enrollment.

The old way used to be not to hold the insured accountable for others actions. A short notice of loss of coverage shouldn't leave them out in the cold. Again, perhaps it does.

We deleted the app and started over. The process went through to the point of paying where the link went to BCBST site (Blue Access) where is is requiring a logon. The client doesn't have one. Rather than creating one under her existing ID, I'll call tomorrow & have them walk me through so we don't get wrong info in the database that needs to be corrected.

I doubt that I'll be doing this for anyone besides friends. It's a pita for almost no money.

My reasoning is simple. You are not playing by the law, you are playing by the rules they make up. The 60 day rule being brought up only relates to how long she has to apply. Not to when the policy goes into effect. Some carriers may allow next day enrollment off exchange, but I have yet to see next day on exchange enrollment.

 

[drnoitall33]

My reasoning is simple. You are not playing by the law, you are playing by the rules they make up. The 60 day rule being brought up only relates to how long she has to apply. Not to when the policy goes into effect. Some carriers may allow next day enrollment off exchange, but I have yet to see next day on exchange enrollment.

But, as I and a few others above have said, we have seen next day enrollment on-exchange. It is not our decision nor the clients, but when you say coverage ends 9/30/14, in my experience, the FFM automatically makes the effective date 10/01/14.

 

[RayNY]

But, as I and a few others above have said, we have seen next day enrollment on-exchange. It is not our decision nor the clients, but when you say coverage ends 9/30/14, in my experience, the FFM automatically makes the effective date 10/01/14.

Further, the law states that coverage must be effective "the first of the month following the loss of coverage". It's a black-and-white rule, not an interpretation or ruling.

I've cited that part so many times, I'm not going to bother this time.

Tim is right with the "playing by their rules, not the law" statement. Nonetheless, coverage should be effective the first of the next month so long as the application is submitted within 60 days. We've had people successfully obtain it, and, of course, some have had issues with it. The resolution appears to be calling the exchange over and over until one of the reps does what you tell them to.

 

[timsip]

But, as I and a few others above have said, we have seen next day enrollment on-exchange. It is not our decision nor the clients, but when you say coverage ends 9/30/14, in my experience, the FFM automatically makes the effective date 10/01/14.

I never said it isn't possible. I am just saying that when dealing with insurance now, you have to play by their rules. Don't like the answer you get from the call center? Hang up and call again. Get another rep. You get all new rules.

Hell, rules change from one side of an election day to another.

You are always wrong and they are always right. Get used to it.

Always have your client on the phone or able to see your screen when working with them. When they see what you see or hear what you hear, they know that you aren't the wackjob that keeps changing things or is coming up with ridiculous rules.