Special Enrollment Can't Buy Coverage

[junkman]

I had a small TN group client tell me Thursday 11/20 that they are dropping coverage effective 11/30. I went to healthcare.gov with one of the employees to enroll effective 12/1 and receive the subsidy. The site wouldn't allow it so I called the 800#.

No dice. Per the people that answered the 800# at healthcare.gov, they can't buy coverage with an effective date before 1/1/2015. WTF???? A qualifying event is SUPPOSED to be a qualifying event - apparently it isn't if it happens after the 15th. Is there any work around?

I will see if I can get the employer to term effective 12/30 but that probably isn't an option. Of course, there is no state continuation when the group terms.

 

[drnoitall33]

If I'm understanding you correctly, the way to get this done is by selecting the 2014 app, and during the app near the end (the "optional" questions) it asks if you are losing coverage in the next 30 days. You say yes, enter in 11/30/14, and boom it gives you a 12/1 effective.

 

[BeeSelective]

I find marketplace doesn't always understand sep

 

[timsip]

They are right, you are wrong. Your answer is STM.

 

[TxOnline]

For On-Exchange SEP's:
Apply BY the 15th........Effective date = Next 1st-of-the-month
Apply AFTER the 15th...Effective date = Second-following 1st-of-the-month

Apply BY Nov 15th......Eff date = Dec 1st
Apply Nov 16-30th......Eff date = Jan 1st

I think the law says otherwise.
But, the FFM is using above formula.

Certain insurance companies are DIFFERENT.
They are "following the law" (per their legal departments) and telling us that SEP's will be handled like this .......for OFF-exchange SEP apps:
Losing coverage effective 11/30......Effective date = Dec 1st

If they want a subsidy (ON-exchange app), they are forced to play by the rules that have been established by the FFM.

 

[drnoitall33]

For On-Exchange SEP's:
Apply BY the 15th........Effective date = Next 1st-of-the-month
Apply AFTER the 15th...Effective date = Second-following 1st-of-the-month

Apply BY Nov 15th......Eff date = Dec 1st
Apply Nov 16-30th......Eff date = Jan 1st

I think the law says otherwise.
But, the FFM is using above formula.

Certain insurance companies are DIFFERENT.
They are "following the law" (per their legal departments) and telling us that SEP's will be handled like this .......for OFF-exchange SEP apps:
Losing coverage effective 11/30......Effective date = Dec 1st

If they want a subsidy (ON-exchange app), they are forced to play by the rules that have been established by the FFM.

I have helped quite a few groups disband coverage, and some do it (very irresponsibly!) last minute. Meaning, it can be past the 15th of the month and their coverage is ending the 30th, we've gotten plenty of people 1st of month coverage using the above method on FFM in Virginia. Just my personal experience but done it a few dozen times!

 

[junkman]

They are right, you are wrong. Your answer is STM.

Perhaps, perhaps not. Please provide your reasoning.
She has a qualifying event and is processing before the effective date. The written documentation that I've seen says she has 60 days from a qualifying event in which to apply. I haven't seen effective dates noted for a given application date other than for open enrollment.

The old way used to be not to hold the insured accountable for others actions. A short notice of loss of coverage shouldn't leave them out in the cold. Again, perhaps it does.

We deleted the app and started over. The process went through to the point of paying where the link went to BCBST site (Blue Access) where is is requiring a logon. The client doesn't have one. Rather than creating one under her existing ID, I'll call tomorrow & have them walk me through so we don't get wrong info in the database that needs to be corrected.

I doubt that I'll be doing this for anyone besides friends. It's a pita for almost no money.

 

[TxOnline]

The insurance companies are all telling us that they cannot override a decision (an effective date) made by the FFM.....for ON-Exchange apps.
They are forced to accept the effective date assigned by the FFM.

You are correct.
The law says that they have 60 days from QLE.
But, they MAY have issued additional rules/regulations since then.
None of us can keep up with ALL of their changes any longer.

Your chosen insurance company (BCBST) can guide you BEST.


_________________

For what it's worth, here's info from the horse's mouth:
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

...

 

[Post Quartermaster]

For On-Exchange SEP's:
Apply BY the 15th........Effective date = Next 1st-of-the-month
Apply AFTER the 15th...Effective date = Second-following 1st-of-the-month

Apply BY Nov 15th......Eff date = Dec 1st
Apply Nov 16-30th......Eff date = Jan 1st

I think the law says otherwise.
But, the FFM is using above formula.

That is incorrect. I submitted multiple apps on Friday (11/21) for 12/1 effective SEPs. I have also submitted SEPs nearly every month since last OEP, after the 15th, with effective dates on the 1st of the month immediatley following.

 

[Ann H]

On November 18th, I submitted 2 SEPs through healthcare.gov, and both of them got a 12/1/2014 effective date.