Help: Older Thread, 15 Day Cut Off for SEP 1st of Mo Cog Eff. Date?

[yorkriver1]

Time is running out, and I can't locate an older thread about this:
It's possible a HC.gov employee may have manually assigned an 8/1/14 effective date for a SEP with loss of coverage 4/30/14. App date after 15th of month. The employee was helping to counteract the eligibility determination letter from online app gone wrong.

Should be effective 7/1/14. When I called back next day and got a "SEP specialist" the upshot was that "HHS assigned the effective date and we can't change it".

Then I saw Ann's post where she got several exchange apps to go through near the end of the month with 7/1/14 effective dates. Yes, Ann is very good, and I am grateful for her contributions here. We have exchanged info about it, and there's no thing different on mine other than loss of coverage before end of June, hers are losing coverage 6/30.

I had one earlier in the month that did go through for 7/1 with coverage loss 6/30/14.

Not sure if I can escalate this, will call HC.gov and work on it.

Feedback, please, if you recall the thread where we established there should not be a 15 day cut off for SEP/coverage loss, or any other SEP. If I remember correctly, someone had to go higher up at HC.gov to get one of theirs straightened out. Thanks!

 

[RayNY]

No 15 day cutoff for loss of coverage, it's a 60 day SEP window that results in an effective date the "first day of the next month", as per law (45 cfr 155.420 (b)(2)(ii) - I've been citing that a lot recently) regardless of submission date.

"...or in the case where a qualified individual loses minimum essential coverage, as described in paragraph (d)(1) of this section, the Exchange must ensure that coverage is effective for a qualified individual or enrollee on the first day of the following month"

4/30 loss means 5/1 effective so long as you submit before 6/29 (may had 31 days). It also means your SEP is over, good luck.

I'd contact the exchange, ask for 5/1, cite the law, and explain it was THEIR SCREW UP that resulted in your client not getting coverage, and their employees who refused to honor the law and give the effective.

FYI, 45 cfr 155.420 (d)(4) is the section that states the exchange may take action to correct or eliminate the effects of an error/misrepresentation/inaction perpetrated by officers/agents/employees of the Exchange. In your case, it's the inaction of not fixing the effective. They should have the power to override a screw up of an HHS employee as well...

 

[yorkriver1]

"Citing that a lot lately" How is that changing the behavior at HC.gov?

I spoke to HC.gov today. They say their written guidelines tell them to apply the 15 day wait on SEP's. That may account for so many employees saying so.
All they could give me today was to complain to CMS to ask for a change of date.
Is there another level of action at the Marketplace?

Thanks for your truly helpful response.

I was asked to pass on examples of needed "fixes" for one of our senators who is on a committee to look at improving the operation at HC.gov. This is one.

 

[RayNY]

Luckily, I usually cite it to normal humans at carriers, who go "oh, yea, that IS what the law says, let me fix that", or I'm telling associates what to refer to (or, I'm citing it here).

Doesn't change the behavior at the exchange. They have the mentality of "We don't know or care what the law or rules are. We enter the request in the system, if it's denied it's not allowed, if it's approved, it's allowed. We'll request anything you want, just to get you off the phone."