Feds explain exchange line

By BenefitsPro


By Allison Bell

Consumers who got applications into the federally run public exchanges Monday will have until April 30 to choose plans.

Officials at the Centers for Medicare & Medicaid Services said that Monday in a guide to the "in-line special enrollment period" process aimed at agents, navigators, certified application counselors and other exchange user "assisters."

The official open enrollment period for individual commercial "qualified health plans" started Oct. 1 and ended March 31.

The U.S. Department of Health and Human Services and state exchange managers developed the open enrollment period system to try to keep individual QHP buyers from using new Patient Protection and Affordable Care Act health insurance underwriting limits to wait until they get sick to pay for coverage.

From now until Nov. 15, consumers who want to buy individual QHP coverage normally would have to show that they qualify for a special enrollment period because they have gone through a major life change, such as the birth of a child or a loss of job, or because they qualify for a hardship exemption from the usual rules.

HHS has created a broad "in-line SEP" for consumers in the 37 states with HHS-run exchanges who say they were in line to buy coverage but had trouble completing the process.

Consumers who say they had trouble with the HHS HealthCare.gov exchange enrollment system have until 11:59 p.m. April 15 to complete the plan selection process.

CMS officials note that the rules are different for users of paper applications.

If an HHS exchange receives a consumer's paper application by April, that consumer will have until 11:59 p.m. EDT April 30 to select an individual QHP using the in-line SEP, officials said.

Consumers can get the in-line SEP by checking a box online or by calling the HHS exchange system call center.

Consumers who fail to get paper applications in by April 7 or pick QHPs by April 30 may still be able to enroll but may have to do more to document the argument that they qualify for a SEP, officials said.

Originally published on BenefitsPro.com