PPACA Update:

"Open Enrollment" is over - now what?

Friends,

PPACA "Open Enrollment" has ended for families and individuals responsible for purchasing their own health insurance. For those individuals, the next opportunity to enroll in a qualified individual health insurance plan (QHIP) will be the 2014 open enrollment period this coming November (2014) for a January 1st, 2015 effective date. Throughout the 2014 calendar year, you may be eligible to enroll in a QHIP if you have meet one of the following criteria:

Satisfaction of a health insurance "Qualifying Event"

"Qualifying Events" are events that will allow you to enroll in an qualified individual health insurance plan after "Open Enrollment" ends. Qualifying Events include, but are not limited to, the following:

Loss of coverage from your employer or spouse's employer
Going from "Full Time" employment with employer sponsored coverage down to "Part Time" employment and loosing employer sponsored coverage
Loss of coverage through a divorce
Gaining spousal eligibility through marriage
Enrollment of a newborn child
Moving from one state to another state

If you satisfy any of the "Qualifying Events" listed above you may qualify to enroll in a QHIP throughout the year. Please keep in mind that we are simplifying this topic and each individual situation is different. The best way to determine your eligibility for certain is to contact a licensed, marketplace certified Benefit Advisor at Altruis Benefit Consulting. We will review your personal situation, reference the new regulations, and prepare a strategy to facilitate the change in coverage

Satisfaction of a "Limited Circumstance Special Enrollment Period"

Over the course of the first "Open Enrollment" for PPACA, everyone can agree that the Health Insurance Marketplace (HIM) left much to be desired from a functional perspective. As a result of these functional challenges, CMS has decided to extent "Open Enrollment" through 4/15/2014 for those individuals who have experience technical issues prior to 03/31/2014 which were not resolved in time to enroll in a plan.

That being said, if a consumer experiences any of the following issues, the HIM may be able to provide a Special Enrollment Period (SEP) allowing the consumer to enroll in coverage through the Marketplace.

Limited Circumstance SEP	Description	Examples
Exceptional Circumstances	A consumer faces exceptional circumstances as determine by CMS, such as a natural disaster, medical emergency, and planned system outages that occur on or around plan selection deadlines	A natural disaster, such as a an earthquake, massive flooding, or hurricane A serious medical condition, such as an unexpected hospitalization, or a temporary cognitive disorder A planned HIM system outage, such as SSA system outage
MIsinformation, Misrepresentation, or Inaction	Misconduct by individuals or entities providing formal enrollment assistance (i.e. insurance carrier, navigator, or certified benefit advisor) resulting in one of the following: A failure to enroll the consumer in a plan Consumers being enrolled in the wrong plan against their wishes The consumer did not receive "advanced premium tax credits" or "cost sharing reductions" for which they were eligible	Representative enrolled a consumer in a plan that the consumer did not want to enroll in
Enrollment Error	Consumers enrolled though the Marketplace, but the insurance company didn't get their information due to technical issues	consumer's information is received by the insurance carrier and may be processed, but the enrollment file contains defective or missing data.
System errors related to immigration status	An error in the processing of applications submitted by immigrants caused the consumer to get an incorrect eligibility result when they tried to apply for coverage	Immigrants with income under 100% of the poverty line are eligible for premium tax credits and cost-sharing reductions did not receive the proper determination
Display errors on HIM website	Incorrect plan data was displayed at the time the consumer selected the QHIP, such as a plan benefit and cost-sharing information	Data errors on premiums, benefits, copay, or deductibles
Medicaid/CHIP Marketplace transfer	Consumers who were found ineligible for Medicaid or CHIP and their applications weren't transferred between the State Medicaid or CHIP agency and the Marketplace in time for the consumer to select a plan during open enrollment	Consumers, who applied at through the HIM, were assessed eligible for Medicaid or CHIP, were found ineligible for Medicaid or CHIP by the state agency and then weren't transferred back in time for an HIM determination during open enrollment
Error Messages	A consumer is not able to complete enrollment due to error messages	Error or box screen indicating that the data sources were down and they could not proceed with enrollment
Unresolved casework	A consumer is working with a caseworker on an enrollment issue that is not resolved prior to March 31st.	Consumers who began the case work process but it was not resolved prior to the end of Open Enrollment
Victims of domestic abuse	A consumer who is married, and is a victim of domestic abuse. Consumers who are in this category can apply and select a plan through May 31st, 2014	Prior to clarifying guidance from Treasure and HHS, consumer assumed or was informed that APTC were unavailable to consumers who are married and not filing a joint tax return. Consumer may or may not have attempted to apply
Other system errors	Other system errors, as determined by CMS, which hindered enrollment completion

There are specific processes to initiate a Limited Circumstance SEP and the licensed, insured, and HIM certified benefit advisors at Altruis Benefit Consulting are extensively trained on how to execute them. If you believe that you may qualify for one of these Special Enrollment Periods please contact us to learn more!

info@altruisbenefit.com

877.44.ALTRUIS (877.442.5878)

Kind Regards,

Anthony P Fracchia

Partner/Co-Founder

Altruis Benefit Consulting

altruis benefit consulting

Empower yourself! We have earned the trust of over 200 Michigan employers through our use of innovative technology and over 50 years of combined market experience. Contact us today to see how our products and services continue to evolve with today's changing marketplace.

877.442.5878 | www.altruisbenefit.com | info@altruisbenefit.com

Connect with US!