The Universal SEP

[Yagents]

FLM, sounds like you did everything legit. All that matters is the wizard behind the curtain thinks it's an SEP.

 

[taterpeeler]

It's not but the Marketplace only asked if her income had changed. I understand this isn't a SEP per the definition of the law but pointing out where the marketplace apparently doesn't care about what the law says, isn't that consistent with Obama-think?

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The original plan was Off Exchange.

I did not do anything to encourage or discourage the applicant from applying, I said we could answer the questions as they were asked and see what the response was-in this case they granted the SEP and issued the policy. Nowhere did we state she lost group coverage because she hadn't.

flm, relax. it was not directed at you... it was directed at comments related to confusion that leaving an aca plan onto another aca plan resulted in an sep... not at you brother

 

[FLM2]

flm, relax. it was not directed at you... it was directed at comments related to confusion that leaving an aca plan onto another aca plan resulted in an sep... not at you brother

Thanks, my point in posting this originally was that others could use this to enroll people now instead of waiting for OEP-if a consumer applies online and answers these questions they will be granted the SEP.

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FLM, sounds like you did everything legit. All that matters is the wizard behind the curtain thinks it's an SEP.

You are 100% correct, it's whatever the wizard behind the curtain thinks and, based on the way POTUS feels like he make adjustments in the law at will, this isn't a surprise, is it?

 

[houcoogster]

flm, relax. it was not directed at you... it was directed at comments related to confusion that leaving an aca plan onto another aca plan resulted in an sep... not at you brother

You all were confused. I stated WHY this case went though. Hc.gov did not ask him if it was group or indy or anything else. That is why it went though. The software triggered the SEP based on this information. I'm not suggesting nor advocating anything. Always call hc.gov for clarification.

 

[Yagents]

It's not but the Marketplace only asked if her income had changed. I understand this isn't a SEP per the definition of the law but pointing out where the marketplace apparently doesn't care about what the law says, isn't that consistent with Obama-think?

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The original plan was Off Exchange.

I did not do anything to encourage or discourage the applicant from applying, I said we could answer the questions as they were asked and see what the response was-in this case they granted the SEP and issued the policy. Nowhere did we state she lost group coverage because she hadn't.

Did you state anywhere on the application that she lost ANY type of coverage?

 

[Ann H]

First off this is NOT loss of employer coverage, period. The consumer has a current individual plan that meets MEC stds, it is a current off market ACA plan. The plan is neither renewing or terminating and never, ever had anything to do with the employer... the "special" deal was between her and the former employer. The employer did not purchase nor apply for this plan.

Of course any agent could state that to the HC.GOV rep and due to how stupid they are they will grant it but this should be noted, the FFM does have a history of what plan you currently have.... how do I know this? Simple, I was messing around with a client one day and for whatever reason I clicked a box incorrectly and up poped her current ACA plan... freeked the crap out of me.... Trust me they know.

Again, an ACA paid for by either the client, the boogy man or the cookie monster is still a ACA plan and if the cookie monster decided to stop paying the premium its still voluntary loss of coverage.... A real group plan that meets group law and standards is an entirely different story which Ann can more that speak about.

Lastly, anyone agent or client that goes into this situation attempting to state loss of group coverage is not following the rules as pursuant to federal law. Now, how do you get caught? well, that's another story in and of itself. Im sure when the end of the year happens and the marketplace sees an old ACA plan then another subsidzed plan will raise red flags me as and agent would not want to submit

I agree wholeheartedly with your post, Charles. I ask myself about other types of fraud that the government regulators overlook/accept. If a doctor knows that Medicare will pay a claim billed in a certain way, but that claim is fraudulent, is the fact that Medicare approves and pays it a justification for filing it? If the Supplemental insurance pays based on Medicare's approval, is that okay? No, and many doctors have gone to jail over fraudulent claims, even though they thought at the time that they would never get caught. I think this is like that. Just because headache.gov lets it pass, and stamps "SEP" on something doesn't make it correct. I appreciate the original poster for wondering out loud how this happened. There are many correct SEPs. And there are many confusing issues that hc.gov is rightfully tasked with sorting out in order to grant legitimate SEPs. It's a shame that the system is so loose, and the rules so easily mutilated. It is understandable if an agent or client doesn't really know if the situation is an SEP or not, and calls to inquire or to apply for one. But it's not understandable if there is clear knowledge of the rules, but manipulation of the system. My opinion only. Your opinion may vary.

 

[houcoogster]

I agree wholeheartedly with your post, Charles. I ask myself about other types of fraud that the government regulators overlook/accept. If a doctor knows that Medicare will pay a claim billed in a certain way, but that claim is fraudulent, is the fact that Medicare approves and pays it a justification for filing it? If the Supplemental insurance pays based on Medicare's approval, is that okay? No, and many doctors have gone to jail over fraudulent claims, even though they thought at the time that they would never get caught. I think this is like that. Just because headache.gov lets it pass, and stamps "SEP" on something doesn't make it correct. I appreciate the original poster for wondering out loud how this happened. There are many correct SEPs. And there are many confusing issues that hc.gov is rightfully tasked with sorting out in order to grant legitimate SEPs. It's a shame that the system is so loose, and the rules so easily mutilated. It is understandable if an agent or client doesn't really know if the situation is an SEP or not, and calls to inquire or to apply for one. But it's not understandable if there is clear knowledge of the rules, but manipulation of the system. My opinion only. Your opinion may vary.

Ann do I at least get a "thank you" for figuring out how it happened???

 

[taterpeeler]

did I miss something flm never clicked the box LOSS OF COVERAGE..... am I correct on this fact or did I miss read flm's post?

 

[Yagents]

You are speculating. We don't know what exactly happened yet. Waiting on FLM's response to my inquiry about "loss of coverage" selected or not.

 

[taterpeeler]

I see me and Hollywood are on the same train.......