The Universal SEP

[FLM2]

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?

Correct, the Loss of Coverage box was never clicked-that specifically relates to group coverage.

 

[taterpeeler]

Correct, the Loss of Coverage box was never clicked-that specifically relates to group coverage.

ok, great.... now, one last question... what the loss of health coverage checked as it relates to ANY coverage.....

what we are attempting to clear up here since some think loss of coverage is the reason for the sep is if any box related to loss of coverage was clicked yes.....

 

[Yagents]

Correct, the Loss of Coverage box was never clicked-that specifically relates to group coverage.

We are trying to figure out if the SEP was given out based on a change of income only, or if a ANY box was selected stating loss of coverage?

 

[Ann H]

I'm on the same train with you, Charles and Yagents. After all, the original poster, FLM2 said the SEP went through when he clicked "change in income", not "loss of coverage". Yet Houcoogster is claiming it was due to loss of coverage.

I had a client yesterday who just lost her job (her employer pays the premium for an individual plan for her as a reimbursement, after tax, of course) and can no longer afford the premium.

We went to healthcare.gov and, as soon as we clicked 'my income has changed' (which it has) as a reason for requesting the SEP it was approved with no further questions or documentation requested in the eligibility letter...

It is weird because all I did was answer the questions honestly, once we said her income was changing the application went right through.

I posted this thread because it seems like the Marketplace is circumventing the law as most of us interpret it...

Dave, the prior plan is not group coverage so this did not create a SEP with the company providing the Off Exchange policy.

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?

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.

Houcoogster, I can give you this. You reiterated that hc.gov doesn't ask the right questions about loss of coverage, including asking if it was voluntary or if it was loss of group coverage after loss of job, etc. But FLM2 said the SEP happened immediately after answering the "change in income" questions. And, we all know that voluntary loss (lapsing) your plan is not legally an SEP. At the very best, if FLM2 answers back and says he said anything at all about a loss of coverage, then I can give you credit for pointing out the way in which hc.gov screwed it up and gave out an illegitimate SEP.

 

[FLM2]

ok, great.... now, one last question... what the loss of health coverage checked as it relates to ANY coverage.....

what we are attempting to clear up here since some think loss of coverage is the reason for the sep is if any box related to loss of coverage was clicked yes.....

I didn't check any box about loss of group or any other coverage, just the one about change in income-I did that purposely to make sure there could be no possible issues with the enrollment if it went through.

Even though it wasn't asked, her change in income made a big change in her eligibility for Cost Sharing Plans and I believe that alone is a reason for a SEP (but they never asked about how much her income changed, just the reason for the income change, which was loss of job).

I know this doesn't seem to make any sense but it's Obamacare, right?

 

[Ann H]

I didn't check any box about loss of group or any other coverage, just the one about change in income.

Even though it wasn't asked, her change in income made a big change in her eligibility for Cost Sharing Plans and I believe that alone is a reason for a SEP (but they never asked about how much her income changed, just the reason for the income change, which was loss of job).

I know this doesn't seem to make any sense but it's Obamacare, right?

Bingo. The "change in income" generated the SEP.

In answer to your statement that maybe "her change in income made a big change in her eligibility for Cost Sharing Plans and I believe that alone is a reason for a SEP", that change in income could conceivably be stretched to help her qualify. She has to be NEWLY eligible, and you said that she was eligible for APTC previously, so it's not that. However, the loss of job triggering income low enough for CSR could make her "newly eligible", I suppose. But it sounds like they didn't even ask the income questions, because you said, "but they never asked about how much her income changed, just the reason for the income change, which was loss of job." It's quite a stretch to believe a loss of job means loss of group coverage, or that a loss of job means your income will be so low as to be newly eligible for CSR, or that loss of job means that your full household MAGI for the whole calendar year 2014 would be that low. It's clear that hc.gov was giving out an SEP mightly quickly without taking many details into consideration.

 

[taterpeeler]

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

I can tell you point blank Ann does not owe you a thank you for squat on this. You did not figure it out and this matter is settled. Was not, nor was it ever related to loss of coverage based on the current facts posted by the OP.

Next case your honor

 

[FLM2]

Bingo. The "change in income" generated the SEP.

In answer to your statement that maybe "her change in income made a big change in her eligibility for Cost Sharing Plans and I believe that alone is a reason for a SEP", that change in income could conceivably be stretched to help her qualify. She has to be NEWLY eligible, and you said that she was eligible for APTC previously, so it's not that. However, the loss of job triggering income low enough for CSR could make her "newly eligible", I suppose. But it sounds like they didn't even ask the income questions, because you said, "but they never asked about how much her income changed, just the reason for the income change, which was loss of job." It's quite a stretch to believe a loss of job means loss of group coverage, or that a loss of job means your income will be so low as to be newly eligible for CSR, or that loss of job means that your full household MAGI for the whole calendar year 2014 would be that low. It's clear that hc.gov was giving out an SEP mightly quickly without taking many details into consideration.[/QUOTE]

Ann, that is exactly what is happening and why I posted this thread. The reason I even tried it is because of a post some months ago from the guy who claimed he worked at the Marketplace that said 'we have been instructed to allow all SEPs' he specifically said this:


mattcvick

Expert



Join Date: Apr 2014

Posts:36

State: mattcvick is an Insurance Agent from

We Are Closed !!! Re: We Are Closed !!! Go to Top
--------------------------------------------------------------------------------

We here at the FFM have been instructed we cannot deny ANYONE an SEP. If a consumer insists we have been instructed to complet ethe application and then submit the account to the HICS department.
Just an FYI for any of you who are interested in continuing.

If the consumer does NOT have an application:
1) Complete an application on behalf of the consumer and review eligibility results, if the consumer qualifies for SEP, enroll them in coverage.
2) There may be times when you will need to add an SEP.
3) If the consumer does not qualifiy for a listed SEP, but they INSIST that they should, perform these steps:
* Add an SEP
* Enroll the consumer in coverage
* Complete the HICS escalation to CMS

 

[houcoogster]

I can tell you point blank Ann does not owe you a thank you for squat on this. You did not figure it out and this matter is settled. Was not, nor was it ever related to loss of coverage based on the current facts posted by the OP.

Next case your honor

I'm going to tell you Point Blank that you failed to figure out the SEP and I did.

I'm sorry Tater you are just not as smart as you thought.

It is a loss of coverage SEP. By virtue of the way it was entered.

 

[taterpeeler]

I'm going to tell you Point Blank that you failed to figure out the SEP and I did.

I'm sorry Tater you are just not as smart as you thought.

It is a loss of coverage SEP. By virtue of the way it was entered.

oh... ok, the facts are irrelevant.... WTF are you thinking?


facts in this case state you are completely incorrect in your assessment however you will continue to bark your right..... makes perfect sense.... your flat wrong... I know it, you know it and the rest of the world knows it.... I sugest you just move along on this one and stop digging