Well of course. I have had this happen a few times. I told a person X, they called hix and got a "better" answer, called me back to tell me I was wrong.
Those moments really make my day.
Subsidy ?
- Thread starter jwoo689
- Start date
Well of course. I have had this happen a few times. I told a person X, they called hix and got a "better" answer, called me back to tell me I was wrong.
Those moments really make my day.
I've had many of those moments myself...
Had a client lose coverage, and want to apply with a 1-month lapse because "I didn't have any claims that month, so I shouldn't have to pay premium".
I say the law requires the plan to be "effective the first day of the month after the QE" (it does, 45 CFR 155.420(b)(2)(ii) ). Exchange let them apply with a lapse, and it took effect as applied.
I looked like an ***, even holding the law in my hand, reading it verbatim.
Had a client lose coverage, and want to apply with a 1-month lapse because "I didn't have any claims that month, so I shouldn't have to pay premium".
I say the law requires the plan to be "effective the first day of the month after the QE" (it does, 45 CFR 155.420(b)(2)(ii) ). Exchange let them apply with a lapse, and it took effect as applied.
I looked like an ***, even holding the law in my hand, reading it verbatim.
- 2,172
Ray I believe it's 60 days. I have put them through right up to the 60th day.
SEP is 60 days, that's irrelevant to my scenario.
In the case of lost coverage, and I quote the law I cited, "the Exchange must ensure coverage is effective on the first day of the following month" . 5/31 QE means 6/1 effective, plan and simple, even if you apply 7/30.
Client wanted 7/1 (came to me mid-July) because had no claims during the month of June and didn't want to pay.
I said it had to be in effect 6/1, cited the law.
Exchange said and did otherwise...
In the case of lost coverage, and I quote the law I cited, "the Exchange must ensure coverage is effective on the first day of the following month" . 5/31 QE means 6/1 effective, plan and simple, even if you apply 7/30.
Client wanted 7/1 (came to me mid-July) because had no claims during the month of June and didn't want to pay.
I said it had to be in effect 6/1, cited the law.
Exchange said and did otherwise...
