…purchased a policy has stopped taking new patients by the time the enrollee attempts to schedule an appointment. Another regulatory option is to require prominently displayed announcements both online and on all narrow network plan print materials that state the network is limited and urge shoppers to review the provider directory before choosing a policy. There are all sorts of…
…the current federally based Marketplace system automatically dis-enrolls her from her health plan, if she purchased both at the same time. In this case, the enrollee was advised that, to keep her health plan but drop her SADP, the only way to do so is to stop paying premiums for the SADP but continue to pay premiums for her health…
…federal regulators decided early on to delay implementation of some of the new quality reforms in the law so they could focus on core operational issues. But that didn’t stop some states from recognizing the potential of the marketplaces to drive quality improvement and moving forward on their own. In their latest issue brief for The Commonwealth Fund, Sarah Dash,…
…month of the grace period). If a policyholder doesn’t pay all their outstanding premiums by the end of the grace period but actively selects a plan for the new benefit year, then the insurer cannot terminate their coverage in the new plan. And if a policyholder receiving an APTC once again stops paying premiums, insurers must provide a new 90-day…
…her baby need? And, why doesn’t her plan cover maternity services? Under the Affordable Care Act, isn’t maternity a required minimum essential benefit? Can She Switch Plans? Unfortunately, the answer is no. The open enrollment period for coverage in 2014 closed on March 31, 2014. There are life events, such as the loss of a job or a move, that…
…any of the caveats written into federal regulations, including the fact that the only way to qualify for a SEP is if you are already enrolled in a marketplace plan. So if you had purchased insurance outside the marketplace but then experienced a loss of income that made you eligible for tax credits, you do not qualify for a SEP….
…are not allowed to receive consideration directly from a health insurance or stop-loss issuer in connection with enrollment. 3) New standards prohibiting certain conduct. The proposed standards regarding providing gifts or promotional items, conducting “cold calling” type solicitation and using “robo” calling (automatic dialers) were finalized with some helpful clarifications. Gifts or promotional items, unless they are of nominal value,…
…as plan sponsors. Expatriate health plans could include lifetime and annual limits, would not have to provide preventive services, and these plans would not have limits on their administrative costs under the medical loss ratio requirements. (EHCCA Sec 2(a)). 2. A much broader group of people than Americans working oversees could be put into expatriate health plans. While the EHCCA…
…claims costs grew and premiums, which are partially based on year-to-year claims experience, gradually increased. Those policyholders who remained healthy and could purchase less expensive coverage elsewhere have moved on, while those, like you, whom no other insurer wants to cover, are stuck. And, your insurer stopped selling your policy when premiums got too high to be marketable, which has…
…individual mandate penalty. New SEP for COBRA enrollees Federal rules allow individuals eligible for COBRA coverage to gain a special enrollment period when (1) they first become eligible because of a loss of employer coverage and (2) when their COBRA coverage is exhausted. But, as we document in Frequently Asked Question #166 of our Navigator Resource Guide, if you take…
The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.
