Will We Need to Get LEP Removed, PDP...interesting Situation.

yorkriver1

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Virginia
Not seen this one, but not a major veteran....will I be hassling with CMS to remove LEP?
Any experience with getting LEP removed if added?....read on....

Prospect has 25 years + of a really low priced continuation health plan from ex-husbands former employer. Generous, really low cost, and when she T65, they coordinated with Medicare, and she has been on B since 2002. Now with ACA, they have to reconfigure the plan, which triples the price. Prospect now age 75.

Prospect chose PDP and MedSupp, which will be sent in now for 1/1/14. Can't responsibly request cancellation of old plan til medsupp issued. Only after old plan cancelled will they issue letter of creditable coverage. I checked just now, and the RX is creditable on old plan, no exception to when letter sent.

Even though PDP service unit says insured will get CMS letter before LEP added, asking for proof of creditable coverage if any, it may be well into January before HIPAA creditable coverage letter received.

How bad could it be....still prospect pleased at good coverage for half what old plan would have been.
 
Not seen this one, but not a major veteran....will I be hassling with CMS to remove LEP?
Any experience with getting LEP removed if added?....read on....

Prospect has 25 years + of a really low priced continuation health plan from ex-husbands former employer. Generous, really low cost, and when she T65, they coordinated with Medicare, and she has been on B since 2002. Now with ACA, they have to reconfigure the plan, which triples the price. Prospect now age 75.

Prospect chose PDP and MedSupp, which will be sent in now for 1/1/14. Can't responsibly request cancellation of old plan til medsupp issued. Only after old plan cancelled will they issue letter of creditable coverage. I checked just now, and the RX is creditable on old plan, no exception to when letter sent.

Even though PDP service unit says insured will get CMS letter before LEP added, asking for proof of creditable coverage if any, it may be well into January before HIPAA creditable coverage letter received.

How bad could it be....still prospect pleased at good coverage for half what old plan would have been.




I have never sent a letter of creditable rx coverage when submitting PDP application I didn't even think the carriers want you to or will process it on enrollment .Anybody else ever submit creditable coverage letter on application submission?

Anywho I tell my clients who this will affect to respond to letter that carrier will send and I also tell them it's even better to call and verbally attest to prior coverage because it gets processed while your on the phone whereas when you mail it in it sometimes finds its way on some paper pushers To Do pile and sometimes doesn't get handled right away or it gets lost.I have never had an issue when a client calls and verbally attest.
 
I have never sent a letter of creditable rx coverage when submitting PDP application I didn't even think the carriers want you to or will process it on enrollment .Anybody else ever submit creditable coverage letter on application submission? Anywho I tell my clients who this will affect to respond to letter that carrier will send and I also tell them it's even better to call and verbally attest to prior coverage because it gets processed while your on the phone whereas when you mail it in it sometimes finds its way on some paper pushers To Do pile and sometimes doesn't get handled right away or it gets lost.I have never had an issue when a client calls and verbally attest.

Agree. Never at time of submission. Carrier will send letter post enrollment with a form requesting attestation of prior creditable coverage. If that doesn't resolve it, an appeal to Maximus will. Nothing in this case as described is unusual.
 
Thanks, great answers! So, if she calls, they won't need copy of creditable RX coverage letter. Than's good news, and way easier. Coverage will lapse in Feb, but still better send cancellation for 12/31, JIC.
 
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