The time is here, starting next week, individual clients will need a "Qualifying Event" (QE) to generate a "Special Enrollment Period" (SEP) in order to enroll for coverage at any point between 4/1 and 11/15 when the next Open Enrollment starts.
We've already discussed what counts as a QE, but now for the more practical question, of "how the heck do I make use of an SEP?"
Healthcare.gov states "...In the Marketplace, you generally qualify for a special enrollment period of 60 days following a [Qualifying event]..." The full text of the law agrees: http://www.gpo.gov/fdsys/pkg/CFR-2013-title45-vol1/pdf/CFR-2013-title45-vol1-sec155-420.pdf
So, my client's sole-prop plan terms 6/1 (anniversary), no-fault loss of existing coverage is a QE. Moving to a new carrier and plan as an individual, small group coverage is no longer an option under the new rules.
"Following" that event, there are 60 days of SEP (6/1-8/1, or thereabout). So, starting 6/1 they are in an SEP and can apply. Under the same section of law, apps received between the 1st and 15th are effective the first day of the next month, or 7/1, producing a month lapse.
My exchange rep says they "think" you can request a term letter in advance from the carrier, and use that as proof of an SEP to apply. I informed her that receipt of a letter is not a QE, the contract termination is. She made it very clear she was guessing and can't promise it will work or be accepted. She also implied that the exchange wouldn't let you apply at all unless you can prove an SEP starting 4/1...
Anyone have a solid answer on how to make use of an SEP for an individual? Any guidance or procedures posted anywhere?
We've already discussed what counts as a QE, but now for the more practical question, of "how the heck do I make use of an SEP?"
Healthcare.gov states "...In the Marketplace, you generally qualify for a special enrollment period of 60 days following a [Qualifying event]..." The full text of the law agrees: http://www.gpo.gov/fdsys/pkg/CFR-2013-title45-vol1/pdf/CFR-2013-title45-vol1-sec155-420.pdf
So, my client's sole-prop plan terms 6/1 (anniversary), no-fault loss of existing coverage is a QE. Moving to a new carrier and plan as an individual, small group coverage is no longer an option under the new rules.
"Following" that event, there are 60 days of SEP (6/1-8/1, or thereabout). So, starting 6/1 they are in an SEP and can apply. Under the same section of law, apps received between the 1st and 15th are effective the first day of the next month, or 7/1, producing a month lapse.
My exchange rep says they "think" you can request a term letter in advance from the carrier, and use that as proof of an SEP to apply. I informed her that receipt of a letter is not a QE, the contract termination is. She made it very clear she was guessing and can't promise it will work or be accepted. She also implied that the exchange wouldn't let you apply at all unless you can prove an SEP starting 4/1...
Anyone have a solid answer on how to make use of an SEP for an individual? Any guidance or procedures posted anywhere?