Sentences with phrase «including special enrollment periods»

In the January 22, 2013 Federal Register (78 FR 4594), we published a proposed rule amending certain special enrollment periods, including the special enrollment periods described in § 155.420 (d)(3) and (7).

Comment: Several commenters requested that new special enrollment periods be added, including a special enrollment period for pregnancy or a special enrollment period for qualified individuals who are automatically re-enrolled into a QHP that does not meet their health coverage needs.

Not exact matches

With respect to effective dates other than regular effective dates, meaning retroactive or accelerated coverage effective dates resulting from enrollment under certain special enrollment periods (including birth and marriage), resulting from the resolution of appeals, or resulting from amounts newly due for prior coverage based on issuer corrections of under - billing, we considered a premium payment deadline of 10 - 15 business days from when the issuer receives the enrollment transaction.

Response: HHS has issued technical guidance, including the Standard Companion Guide Version 1.5 (issued March 22, 2013), which provides Exchanges with the information necessary to build the ability to send the reason for Special Enrollment Periods on the enrollment trEnrollment Periods on the enrollment trenrollment transaction.

Comment: We received general support for the proposed changes to include non-Exchange entities in the special enrollment period where enrollment or non-enrollment in a qualified health plan through the Marketplace is a result of the error of the Exchange.

We note that, as specified in the proposed rule, this policy provides a special enrollment period inside the Exchange for individuals whose coverage in group health plans and individual market plans offered outside of the Exchange is expiring, including grandfathered and transitional plans.

As noted by commenters, non-enrollees may be determined eligible for other special enrollment periods including that for loss of coverage.

Comment: Several commenters urged HHS to clarify the proposed changes to the special enrollment period for a permanent move, including specifying that consumers must submit proof of a change of address and providing clarification that changes to the special enrollment period for a permanent move Start Printed Page 10798includes individuals who are being released from incarceration.

We recognize the potential for confusion, as coverage offered through an Exchange is offered by «a health insurance issuer in the individual market,» but this coverage is subject to the special enrollment rule at § 155.420 (d), which is intended to require special enrollment periods for triggers including those listed in the exceptions in paragraph (b)(2)(i).

In response to our request for comment and data to assess whether special enrollment periods are being abused and to minimize potential misuse and abuse of special enrollment periods, commenters expressed strong support for the Exchange to take actions to verify consumer eligibility for special enrollment periods moving forward, including requesting documentation supporting consumers» eligibility for special enrollment periods.

Section § 155.420 (d)(1) establishes a special enrollment period for qualified individuals who lose certain types of coverage, including minimum essential coverage.

Comment: Commenters expressed concerns about current misuse or abuse of special enrollment periods, including consumers who inappropriately obtain a special enrollment period on the basis of a loss of minimum essential coverage after being terminated from coverage due to a failure to pay premiums in violation of § 155.420 (e)(1).

Thus, at the Exchange's option, qualified individuals who qualify for a special enrollment period due to gaining or becoming a dependent through birth, adoption, placement for adoption, placement in foster care, or through a child support or other court order, would be able to elect from the same coverage effective date options, including: the date of qualifying event, the first day of the month following plan selection, or regular coverage effective dates in accordance with paragraph (b)(1).

We propose that the special enrollment periods specified in § 155.725 (j) would continue to be applicable in the SHOPs for plan years beginning on or after January 1, 2018, and propose to include these in § 155.726 (c).

Other commenters requested the expansion of existing special enrollment periods, including adding provider network and drug formulary errors to the special enrollment period for plan or benefit display errors under paragraph (d)(4) of this section, allowing dependents of Indians to enroll in or change enrollments along with the Indian through the special enrollment period in paragraph (d)(8) of this section, and allowing for a retroactive coverage start date for consumers who qualify for the special enrollment period due to a loss of minimum essential coverage in paragraph (d)(1) of this section.

State - based exchanges have some flexibility in terms of some special enrollment periods, although CMS indicated that the special enrollment period for people whose plans are discontinued at year - end is available in every state, including state - based exchanges, regardless of whether the exchange mapped those enrollees to plans from different insurers or not.

Qualifying events literally qualify you for a special enrollment period; some examples of qualifying events include turning 26, getting married, and having baby.

If you don't qualify for a special enrollment period, you have a few options, including off - exchange plans (a few private health insurers sell them outside the open enrollment period), short - term health insurance, limited benefit plans or prescription discount cards.

Special Enrollment Periods include things like having a baby, losing your job where you had employer - provided health insurance, and moving to a new zip code where you may need to look for a new plan.

Special enrollment periods are generally triggered by big life events, including:

There are a variety of reasons for this, including the fact that the ACA's individual mandate penalty is not particularly enforceable, and the fact that special enrollment period eligibility has been somewhat lax; there's no single reason for the lower - than - expected number of healthy enrollees.

Get more information on confirming your Special Enrollment Period eligibility, including which documents you can submit

With respect to effective dates other than regular effective dates, meaning retroactive or accelerated coverage effective dates resulting from enrollment under certain special enrollment periods (including birth and marriage), resulting from the resolution of appeals, or resulting from amounts newly due for prior coverage based on issuer corrections of under - billing, we are considering a premium payment deadline of 10 - 15 business days from when the issuer receives the enrollment transaction.

The 2014 plan data applies only to plans offered during 2014, including those purchased after March 31, 2014 with a Special Enrollment Period.

You may qualify for a Special Enrollment Period if you lose health coverage through your employer or the employer of a family member, including if:

You may qualify for a Special Enrollment Period if you lose individual health coverage, including if:

You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.

So although your special enrollment period will give you the option of enrolling outside the exchange if you prefer, you can't get a subsidy to help pay for health insurance not purchased through your exchange (that includes COBRA; if you opt to keep your coverage via COBRA, you'll have to pay the full premium yourself).

If you have a health plan that includes dental benefits, you can change to another health plan without dental benefits only during Open Enrollment, unless you qualify for a Special Enrollment Period.

Involuntary loss of coverage (which includes losing coverage because you voluntarily quit your job) is a qualifying event, and makes you eligible for a special enrollment period in the individual market, either in the exchange or off - exchange.

So the ACA included two provisions to prevent this: The individual mandate that penalizes people who choose to go without insurance, and the limited open enrollment windows and special enrollment periods (i.e., you can't just enroll anytime you like).

We also proposed to explicitly state that the requirement for Exchanges to ensure appropriate actions are taken in connection with retroactive terminations, currently set forth in paragraph (d)(6) regarding special enrollment periods, applies to all retroactive terminations, including valid cancellations of coverage under a «free look» law.

Changes include different dates for the annual Individual and Family Health Insurance Open Enrollment Period, stricter Special Enrollment eligibility rules including requirements to provide proof of prior coverage.