Health Insurance Marketplace Special Enrollment Periods in the Federally- facilitated Marketplace March 2015

Health Insurance Marketplace

Special

Enrollment

Periods in the Federally-facilitated

Marketplace

March 2015

Annual Open Enrollment Period (OEP)• The OEP for coverage in 2015 ended February 15

• For coverage in 2016, the OEP will be November 1-January 31

During a Special Enrollment Period (SEP), if eligible Once per month if member of federally recognized

Indian tribe or Alaska native shareholder

When You Can Enroll in CoverageWhen You Can Enroll in Coverage

March 2015 Marketplace Special Enrollment Periods 2

Outside Open Enrollment, you can enroll if you’re eligible for an SEP because you have• A qualifying life change, or • Another qualifying circumstance

Most SEPs last 60 days from the date of the qualifying event• 30 days in the Small Business Health Options Program

(SHOP) Marketplace

Special Enrollment Periods (SEPs)Special Enrollment Periods (SEPs)


Marketplace Special Enrollment Periods 4

You may obtain a SEP to enroll in 2015 coverage if you• Aren’t currently enrolled in coverage through the Health

Insurance Marketplace for 2015,• Were subject to owe the fee on your 2014 federal income tax

return for not having health coverage in 2014, and• Attest that you were unaware of, or didn't understand, the ACA

requirement to maintain minimum essential coverage until after February 15, 2015 (the end of the 2015 Open Enrollment Period)

• This Special Enrollment Period will start on March 15 and end at 11:59 pm E.S.T. on April 30, 2015

2015 Limited Special Enrollment Period for Tax Season–Federally-facilitated Marketplace

2015 Limited Special Enrollment Period for Tax Season–Federally-facilitated Marketplace

March 2015

Life Changes That May Qualify You For a Special Enrollment Period

Life Changes That May Qualify You For a Special Enrollment Period

Getting married Having a baby Adopting a child or placing a child for adoption or foster care Losing other health coverage (minimum essential coverage) due to

• Resigning, getting laid off, or getting fired

• Divorce (see slide 7)

• COBRA coverage ending (but not cancelling it yourself before it expires)

• Aging off a parent’s plan when you turn 26

• Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP) Continued on next slide


Life Changes That May Qualify You For a Special Enrollment Period (Continued)

Life Changes That May Qualify You For a Special Enrollment Period (Continued)


Permanently moving outside your plan’s coverage area Gaining citizenship or lawful presence in the U.S. Gaining or continuing status as a member of an Indian

tribe or an Alaska Native shareholder Leaving incarceration For people already enrolled in Marketplace coverage

• Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

Divorce and legal separation can change your Marketplace coverage options• You may lose coverage if you were enrolled through

a spouse/partner who removes you from coverage• You may no longer need to keep a spouse or partner

on your plan due to divorce or separation You can qualify for an SEP once the divorce or

separation is legally finalized

Divorce/Legal Separation Life ChangesDivorce/Legal Separation Life Changes


How to Use a Special Enrollment Period for a Life Change

How to Use a Special Enrollment Period for a Life Change

If you have a qualifying life change, you can contact the Marketplace• Online at HealthCare.gov

Log into your account and click on Report a life change

• By phone Call the Marketplace Call

Center at 1-800-318-2596 TTY 1-855-889-4325


Online at HealthCare.gov/screenerOnline at HealthCare.gov/screener

Use the screening tool to see if you qualify for a Special Enrollment Period

Maricopa County



Answer a Few Questions about Life Changes

Answer a Few Questions about Life Changes

March 2015

Start or Update an ApplicationStart or Update an Application

If it looks like you may qualify, update your old application if you have one, or start a new one if you don’t



Gather Important InformationGather Important Information

Download or print this checklist so you know what information may be needed to apply for coverage

marketplace.cms.gov/outreach-and-education/apply-for-or-renew-coverage.pdf

March 2015

https://marketplace.cms.gov/outreach-and-education/apply-for-or-renew-coverage.pdf



Type of Life Change SEP Plan Selection Date Coverage Effective Date1. Move to a new service area 2. Release from incarceration3. Become lawfully present4. Gain status as an Indian

Between the 1st and 15th day of the month

First day of the following month

Between the 16th and last day of the month

First day of the second following month

Loss of minimum essential coverage (MEC)

Any day of the month First day of the following month

Future loss of MEC (up to 60 days in the future)

Any day of the month First day of the month following loss of MEC

Gaining a dependent through marriage

Any day of the month First day of the following month

Birth, adoption, or placement for adoption or foster care

Any day of the month Day the child was born, adopted, or placed for adoption or foster care

Coverage Effective Dates for Life Change SEPsCoverage Effective Dates for Life Change SEPs


You may be eligible for an SEP if you experienced other qualifying circumstances during Open Enrollment• Enrollment errors

• Exceptional circumstances

• Misinformation, misrepresentation, or inaction

• Specific system issues

• Having current COBRA coverage

• Individual market plan renewal outside of Open Enrollment

• Members of AmeriCorps, VISTA, and NCCC programs

Types of Special Enrollment Periods - Other Qualifying Circumstances

Types of Special Enrollment Periods - Other Qualifying Circumstances


You chose a plan by the deadline, but• Enrollment wasn’t processed by the Marketplace• Insurer doesn’t have the enrollment, or• You were enrolled in the wrong plan

Examples of enrollment errors• Missing enrollment records• Defective enrollments

Enrollment ErrorsEnrollment Errors


Serious situations that prevent you from enrolling by the appropriate deadline• Medical emergency• Natural disaster • Planned system outage

Must submit documentation of medical emergency or natural disaster

Exceptional CircumstancesExceptional Circumstances


Misconduct by a non-Marketplace entity that caused you• To not be enrolled in a plan• To be enrolled in the wrong plan• To not get lower costs for which you’re eligible

Non-Marketplace entity may be an insurer, Navigator, certified application counselor, agent or broker

Misinformation, Misrepresentation, or Inaction

Misinformation, Misrepresentation, or Inaction


1. Call the Marketplace Call Center to request an SEP at 1-800-318-2596 (TTY 1-855-889-4325)

2. Call Center asks questions to determine if you’re eligible

3. If granted, the Call Center activates the SEP4. You can enroll online or through the Call Center5. If your SEP request is denied, you can appeal

General Process for Other Circumstance Special Enrollment Periods (SEPs)

General Process for Other Circumstance Special Enrollment Periods (SEPs)


Generally you have 60 days to select a plan• From date you’re granted Other Circumstance SEP

Plan selection timeframe starts when • You get a letter telling you you’re eligible for an SEP• You contact the Call Center and are found eligible• A Caseworker finds you eligible

Coverage effective dates generally follow regular effective date guidelines

Plan Selection for Other Circumstance Special Enrollment Periods (SEPs)

Plan Selection for Other Circumstance Special Enrollment Periods (SEPs)


Marketplace Eligibility Appeals 20

Requesting a Marketplace Eligibility AppealRequesting a Marketplace Eligibility Appeal

Two ways to request a Marketplace eligibility appeal 1. Complete an appeal request form

Available atHealthCare.gov/can-i-appeal-a-marketplace-decision/

2. Write a letter explaining the reason for the appeal Then mail the request to

Health Insurance Marketplace465 Industrial Blvd.London, KY 40750-0061

01/28/2015

https://www.healthcare.gov/can-i-appeal-a-marketplace-decision/

https://www.healthcare.gov/can-i-appeal-a-marketplace-decision/


You can request an appeal within 90 days of receiving an eligibility determination

You can get help with Marketplace eligibility appeals• Health Insurance Marketplace Call Center- will help by

explaining how to request an appeal 1-800-318-2596 (TTY: 1-855-889-4325)

The Marketplace Appeals Center can answer questions about your appeal after it is filed• Call 1-855-231-1751 (TTY: 1-855-739-2231)

Getting Help With AppealsGetting Help With Appeals

01/28/2015


Navigator program‒can help you ask for a Marketplace eligibility appeal

Appointed representatives‒can request a Marketplace eligibility appeal and speak for the you• Call the Marketplace Appeals Center to learn

more 1-855-231-1751 (TTY: 1-855-739-2231)

Getting Help With Appeals (Continued)Getting Help With Appeals (Continued)

01/28/2015

National Training Program Contact Information

This training module is provided by theCMS National Training Program (NTP)

For questions about training products email [email protected].

To view all available NTP materials, or to subscribe to our email list, visit

cms.gov/outreach-and-education/training/cmsnationaltrainingprogram/

.

mailto:[email protected]

http://cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/

http://cms.gov/Outreach-and-Education/Training/CMSNationalTrainingProgram/

Documents

Health Insurance Marketplace Special Enrollment Periods in the Federally- facilitated Marketplace March 2015