Humana Accepting STM Expiration As QLE

Ill believe this when I see it..sounds too good to be true! Sorry guys lol

The Humana website lets you choose a reason for your SPECIAL enrollment from a drop-down box. You choose "Loss of Coverage" and then proceed to apply. There's no wording stating that verifying documentation needs to be sent in to the company.

Perhaps the only instances in which Humana would attempt to "punish" the person who buys a Humana Plan, coming off of an STM, is if there is a sizable medical claim? I'm sure they still have some people left in the department that tracks down people who lied to get insurance.

But then again, your average Joe and +80% of agents have no idea what Minimum Essential Coverage means anyway. For all they know, an STM is M.E.C.. In this self-serve world, would an arbiter side with an insurer who wants to deny an $82,000 medical claim because the applicant said/believed that he "Lost Coverage", when his Short-Term-Medical expired? Technically, he DID lose coverage. That's all Humana asks.
-ac
 
Proof of QE is necessary for application, as far as I know, if they don't request proof and accept the client, who proceeds to bind coverage, they're on the hook.

It's just like a life company forgetting to order a physical, or a bank issuing a loan without a credit check.

The law is rarely on the side of a corporation that violated their own rules and then wants to penalize a customer who followed their instructions and requirements to the letter.

(However, I don't doubt for a second them trying to deny a claim because of this reason. How successful it is, I'm sure we'll find out soon.)
 
Humana rep says don't push the envelope on STM to ACA. They will ask for certificate of coverage and may want to see the start date. If the effective date was 2013 they might enroll them in Obamacare plan.

But if the eff date is 2014 don't count on getting a policy issued.
 
Ever since this thread was started, I've tried on occassion to find a HHS/CMS/IRS rule which says that Short Term Medical is NOT minimum essential coverage. Can't find anything. Where did we get the idea that a STM plan is not M.E.C.?? It's certainly more substantive than some of the "miscellaneous" programs that are deemed M.E.C. on the IRS and HHS website.

When completing the subsidy application at HC.gov, the website simply asks if you have lost, or will lose a health plan and what date. No question asking if that plan is/was minimum essential coverage...or anything else for that matter.
ac
 
If it is mec, then we could sell it without paying penalty. But we can't. .gov is very broad in their questions and not something I would put my name on.
 
If it is mec, then we could sell it without paying penalty. But we can't. .gov is very broad in their questions and not something I would put my name on.

I want to write a STM and simultaneously enroll a person/family via HC.gov, because they'll be losing their private health plan at the end of the month. Since this administration wants every enrollee it can get, and since I'm a risk taker in all aspects of my life anyway, there's no fear on this end. Besides, I hated the Open Enrollment pressure cooker. Never worked that hard in my life before and never want to again!
 
Ever since this thread was started, I've tried on occassion to find a HHS/CMS/IRS rule which says that Short Term Medical is NOT minimum essential coverage.
ac

Allen, STM's aren't explicitly exluded, however, they fail to meet some of the requirements for an MEC. Since the law requires "all" to be met, missing even one disqualifies STM. For reference, the period of the policy has nothing to do with it, it's the actual plan itself.

45 CFR 155.604, requirements for recognition as MEC: 45 CFR 156.604 - Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart. | LII / Legal Information Institute "plan must meet substantially all the requirements of title 1 of the ACA..."

http://www.hhs.gov/healthcare/rights/law/title/i-quality-affordable-health-care.pdf <Title one of ACA. Here's the commonly missed requirements:
-No lifetime or annual limits (most have limits)
-No cost preventative health care (STM's miss this)
-Must use SBC's (I haven't seen one for an STM)
-No Pre-ex exclusions (STM's I've seen exclude pre-ex)
 
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