…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…
…access to their treating providers. Others might need to use COBRA to maintain coverage through a job-based plan so they can avoid any gap in coverage, even a small one. The opportunity to trigger a SEP 60 days prior to the loss of coverage will help those who know a loss of coverage is coming. But not everyone will have…
…the SEP is granted. SEP for Survivors of Domestic Violence – married individuals who have experienced domestic violence may also receive a limited circumstance SEP until May 31st. Qualifying life event SEP – people who have specific changes in circumstances such as the birth of a child or the loss of other minimum essential coverage may qualify for an SEP…
…include essential community providers. Standard health plans that are insurer based (and not health maintenance organization or provider network based), also have to meet an 85 percent medical loss ratio standard. What’s next? We’ll continue to watch Minnesota and New York and report back on how their Basic Health Programs are taking shape. We’ll also be on the lookout for…
…changes: First, they must apply for coverage under Medicaid, knowing they won’t be found eligible. Second, upon receiving their denial from the state Medicaid agency, they must apply for a hardship exemption. Third, once their income changes, they must notify the Marketplace, and apply for a special enrollment period based on the loss of their hardship exemption. Needless to say,…
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.
