- Thread starter
- #91
- 8,448
FYI..if the "household size" changes due to death, a Special Enrollment is available for the household. (Ex. Grandmother dies who lives in the house. SEP is available for surviving relative(s).)
ac
ac
2014 ACA Enrollment Tips (Agents Helping Agents)
- Thread starter AllenChicago
- Start date
- 1,304
Hmm, Grandma on Medicare not associated to tax filing for the household...isn't this looked at the same as BF and GF living in the same house?
- Thread starter
- #93
- 8,448
I dont know. We went off exchange. Green light was from insurer.
- Thread starter
- #94
- 8,448
7/9/2014
WTF?!? Off-Exchange applicant BCBS-IL. Enrolled 7/9/2014. Policy was made effective by BCBS-IL retroactive to 6/1/2014, because her prior coverage ended on 5/31/2014. At $575.00 per month, she now has to pay for June and July!
Is this another of those crazy ObamaCare mandates, or is BCBS-IL just doing this to be greedy, or something else? She was happy with the 7/9/14 effective date that the application software assigned to her today. Tonight the BCBS-IL website says that she's effective 6/1/2014.
I'm calling the colored company tomorrow, but wanted to see if anyone here has insight into this, because quite frankly, many of you are smarter than the insurance company staffers.
ac
WTF?!? Off-Exchange applicant BCBS-IL. Enrolled 7/9/2014. Policy was made effective by BCBS-IL retroactive to 6/1/2014, because her prior coverage ended on 5/31/2014. At $575.00 per month, she now has to pay for June and July!
Is this another of those crazy ObamaCare mandates, or is BCBS-IL just doing this to be greedy, or something else? She was happy with the 7/9/14 effective date that the application software assigned to her today. Tonight the BCBS-IL website says that she's effective 6/1/2014.
I'm calling the colored company tomorrow, but wanted to see if anyone here has insight into this, because quite frankly, many of you are smarter than the insurance company staffers.
ac
I'm pretty sure its ACA. There can be no lapse in.coverage.
- 599
There can be up to a 63 day lapse in coverage...I think it's a "glitch" in the system...I hope you have luck with them today.
Allen... from my experience this week.... wrote the dad who lost coverage on exchange with his family and they got a 08/01/2014 effective date w/ BCBS... they lost coverage 06/11/14.... another of his kids was not on his tax return therefore had to be written off exchange with BCBS the effective date was 07/01/14.... moral to story I think is write on exchange..... gltch sounds about right
- Thread starter
- #98
- 8,448
You hit the nail on the head, UNIC. Was/Is a system glitch that is related to a US government rule being applied improperly, or something.
The client's effective date has been manually changed by BCBS to 7/9/2014, as it should have been and she's now paid up to 8/9/14, instead of being in a grace period. BCBS even called her to ensure that her hepatitis medications are set up properly.
Thanks to KGMom and TaterPeeler for your feedback as well.
-ac
This is just them following the law. It's the way it's supposed to be. Not a glitch, not improper, not them being greedy.
45 cfr 155.420 (see, there I go, citing that exact same section again)
Specifically, and I quote (the relevant part):
"...in the case where a qualified individual loses minimum essential coverage, as described in paragraph (d)(1) of this section, the exchange must ensure coverage is effective the first day of the following month."
Hope this clears things up.
EDIT: Yes, even if you use the full 60 days of SEP, the plan is retro to the first of the month-clients owe 3 months premium on the first day in this scenario. I've had it happen. This is on or off exchange, any carrier, the same laws apply. Some carriers are blatantly not following this law, so exceptions are available if necessary.
45 cfr 155.420 (see, there I go, citing that exact same section again)
Specifically, and I quote (the relevant part):
"...in the case where a qualified individual loses minimum essential coverage, as described in paragraph (d)(1) of this section, the exchange must ensure coverage is effective the first day of the following month."
Hope this clears things up.
EDIT: Yes, even if you use the full 60 days of SEP, the plan is retro to the first of the month-clients owe 3 months premium on the first day in this scenario. I've had it happen. This is on or off exchange, any carrier, the same laws apply. Some carriers are blatantly not following this law, so exceptions are available if necessary.
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HelpingPeople
Expert
- 48
This happened to me here in mi. Group plan discontinued June 30 .. signed up one employee ON exchange on July 9 for effective date of 8. 1... then signed up another employee OFF exchange with the same company. .. application date July 8 2014. For OFF exchange application they said effective date has to be July 1... This goes against sequencing of enrollment guidelines with effective dates.
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