Who Determines a Qualifying Event and where is It Defined?

hamben

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I am researching several different states and it appears to me that each company is determining what a SEP is and not the actual marketplace.

It appears the marketplace has set a general guidance and again each company is allowed to determine SEP. For example here is BCBSNE application wording.

"Special Enrollment Period Coverage effective dates will be determined by BCBSNE in accordance with state and federal law and will depend on the type of event, the date of request for special enrollment, and the date of plan selection. BCBSNE will determine eligibility for special enrollment. Enrollment is conditioned upon timely payment of premium."

The reason I find this interesting is under SEP they also state

" A Special Enrollment Period of 60 days is available for:

"F. An eligible person whose coverage under a BCBSNE Tempcare Contract is terminated at the end of the full contract term".

Any thoughts?

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Can anyone answer this or reference where in the law or hhs guidance it defines who and what determins what a SEP actually is. All I can find is generalizations. It's never good for a law to have the words like or usually or in most as wording because then excerpting is open to interpolation.
 
Kg, thanks for your help but I have read what you linked and it does not say who determines or actually defines what a SEP is. All is says is a generalization."

"A time outside of the Open Enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. If you don't have a special enrollment period, you can't buy insurance through the Marketplace until the next Open Enrollment period. Job-based plans generally allow special enrollment periods of 30 days."

The text that I was referring to on the BCBS application is on the Applications today and they are the current 2014 apps. If appears to me that each carrier is allowed to determine what qualifies as an SEP and if that is true then if the carrier determines there is a SEP then will they qualify for tax credits in the marketplace if that carrier participates in the marketplace?
 
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