IBC Breaking News: Changes to SEP On-Exchange Verification Process

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logo_ibxChanges to SEP On-Exchange Verification Process
Starting June 17th, 2016 individuals enrolling in coverage through a Special Enrollment Period (SEP) on the Marketplace will need to provide specific documents to verify eligibility for certain SEPs, including:

  • Loss of minimum essential coverage
  • Change in primary place of living
  • Birth
  • Marriage
  • Adoption, placement for adoption, placement for foster care, or child support or other court order

Individuals who apply for these SEPs will be sent an Eligibility Notice for 2016 Coverage by the Centers for Medicaid and Medicare Services. To confirm eligibility and avoid a disruption of coverage, individuals must provide the required documents for each SEP by the deadline indicated within the Eligibility Notice. Sample Eligibility Notices provided are available for viewing here, under “Eligibility Notice – Special Enrollment Periods (2016 coverage)”.

Under the SEP Confirmation Process that CMS is implementing per the February policy announcement, individuals will be told they are eligible and to enroll before their documentation has been verified. If documentation is not verified or not sent in by the date in the Notice, the individual could lose Marketplace coverage and any advance payments of the premium tax credit and cost-sharing reductions (if applicable), and which may include termination retroactive to the original policy effective date.

For more information on this announcement, please see the CMS Fact Sheet. As always contact your Total Benefit Solutions, Inc individual account manager at (215)355-2121 if you have any questions or concerns.

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