CMS cracks down on special enrollment periodsNews added by Benefits Pro on January 21, 2016

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By Jack Craver

Is the fun over for freeloaders? That’s what the federal government and insurance companies are hoping.

In response to complaints from insurers that too many people were exploiting “special enrollment periods” to forgo coverage until they are sick, the federal government is reducing the number of exceptions that allow people to sign up for plans after the standard deadlines.

There are a number of reasons that some people are allowed to buy insurance outside of the designated time, including if they were enrolled in COBRA and were not properly informed about their need to buy health insurance. That excuse, along with five others, will no longer be considered acceptable excuses to sign up for a plan late.

“(T)he Marketplace must be attractive for consumers, and the Marketplace must be attractive for insurance companies that offer plans on it,” explained the Centers for Medicare and Medicaid Services in a blog post explaining that decision and others that it says are aimed at ensuring the marketplace remains viable.

America’s Health Insurance Plans, the trade group that represents most of the country’s major insurers, described the decision as an improvement that nevertheless falls short of what is necessary to protect the system from abuse.

"While this is an important first step, more needs to be done to validate special enrollment requests. It's critical that there is a process in place to avoid potential abuse of special enrollment periods in order to ensure a stable, affordable market for consumers,” said Clare Krusing, an AHIP spokeswoman, in a statement.

CMS also pledged that it would more closely scrutinize requests for special enrollment periods to make sure that those who are seeking an exception to the rules actually qualify for it.

“We will also emphasize more strongly to applicants that the law requires that consumers provide accurate information to the Marketplace, and they may be subject to penalties under federal law if they intentionally provide false or untrue information,” said the department.

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