2014 ACA Enrollment Tips (Agents Helping Agents)

[AllenChicago]

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.

RAY, a HUGE THANK-YOU for finding and sharing the actual ACA wording that describes when ON and OFF Exchange SEP health policies must be effective. Your R.W.I.Q. is off the charts!

Most appreciative,
-AC

 

[RayNY]

You're welcome AC, I'm glad I could help.

I've had on-exchange clients skirt the rule and get different dates-usually a 30 day lapse when they apply after the 15th, which they wanted.

The Exchanges don't care, in the words of the last supervisor I spoke with, it doesn't matter what the law says, "we just put the request in the system and if it goes through it's allowed. If it's kicked back, it's not". Looks like the system doesn't dis-allow this. If your client wants a lapse, contact the exchange and complain.

 

[unic.consulting]

It seems to me that the system defaults to no lapse and no lapse has to be offered, but it's up to the client whether or not they want to backdate their new policy.

 

[AllenChicago]

Subsidy Ceases with Job Commencement, or with Group Coverage Commencement?

If a subsidized client obtains a high-paying job on July 15th, but his health insurance doesn't start until August 15th, will his subsidy stop effective July 15th or August 15th?

This person informed the healthcare.gov marketplace of this new job around July 10th, by phone. They said that the carrier (BCBS) would be removing the Cost-Sharing-Reduction from his Silver plan, but didn't know much more.

Anyone else experience a client becoming non-subsidy-eligible this year due to obtaining a higher paying job?

ac

 

[AllenChicago]

June 16, 2015

If the primary insured ages-off of an on/off exchange QHPlan to Medicare, or dies, the spouse does not automatically become the primary insured.

Outside of Open Enrollment, the spouse/family must purchase a new plan, using "termination of prior coverage" as the reason for enrollment eligibility.

Some companies did not require a new application after the primary insured's departure. But now, ObamaCare says that they all have to.

The above info came from BCBS Producer Support department today.
-ac

Moderators: If you could remedy my short-sightedness and remove "2014" from the title of this thread, I'd appreciate it.

 

[kgmom219]

June 16, 2015

If the primary insured ages-off of an on/off exchange QHPlan to Medicare, or dies, the spouse does not automatically become the primary insured.

Outside of Open Enrollment, the spouse/family must purchase a new plan, using "termination of prior coverage" as the reason for enrollment eligibility.

Some companies did not require a new application after the primary insured's departure. But now, ObamaCare says that they all have to.

The above info came from BCBS Producer Support department today.
-ac

Moderators: If you could remedy my short-sightedness and remove "2014" from the title of this thread, I'd appreciate it.

Thats an INTERNAL BCBS issue!

The system cannot term the spouse listed first and keep the same policy number. Hc.gov doesn't care how it works. A new application is not required. What is required by BCBS is a new policy number, which will generate with the 834 file. Then any monies paid toward the oop will have to be manually transferred.

I'm so tired of PSC being fed internal lies by IT then telling it to producers.

 

[AllenChicago]

Thats an INTERNAL BCBS issue!

The system cannot term the spouse listed first and keep the same policy number. Hc.gov doesn't care how it works. A new application is not required. What is required by BCBS is a new policy number, which will generate with the 834 file. Then any monies paid toward the oop will have to be manually transferred.

I'm so tired of PSC being fed internal lies by IT then telling it to producers.

You're right, KGMom. Since this is a non-marketplace BCBS policy, it's a BCBS processing procedure that's executed when the primary insured is removed. Telling me that the ACA requires that the existing plan be cancelled is just passing off responsibility for an internal BCBS system limitation. Like you said, it's Blue Cross that requires this cancellation and re-write.

What did BCBS do before ObamaCare, if the spouse of the aged-off, or deceased, primary insured had a dread disease? This spouse couldn't just buy a new plan, like she can now. (I didn't write much BCBS before 2014.)