premera blue cross washington individual special enrollment … · 2015. 7. 10. · providing...
TRANSCRIPT
030808 (06-2014)
Premera Blue Cross Washington Individual Special Enrollment Periods
and Qualifying Events Frequently Asked Questions
Overview The Washington State Office of Insurance Commissioner (OIC) adopted a permanent rule December 11, 2013, to address special and open enrollment requirements for Small Group and Individual plans to take effect January 1, 2014. The OIC rule is intended to ensure that issuers administer special and open enrollment periods for the Individual market consistently, inside and outside the exchange. This rule takes the place of the prior emergency rules on the same subject.
No. Question Answer
Questions – Producers
1. What is the special enrollment period? Special enrollment periods are provided when
qualifying events occur and allow eligible participants
and dependents to enroll or request changes to plan
elections outside of open enrollment
periods. Enrollment and changes within a special
enrollment period must be requested within 60 days of
the qualifying event, including the required supporting
documentation.
2. When is the special enrollment period?
The first special enrollment period for Individual
coverage is April 1, 2014, through December 31, 2014.
3. Who can enroll for Individual coverage during the special enrollment period?
Individuals who can prove they’ve had a qualifying
event are eligible for coverage on one of our ACA-
compliant Individual health plans during the special
enrollment period, inside and outside of the exchange.
4. What Individual health plans are available during the special enrollment period?
Any of our Individual plans that comply with the ACA
(i.e. metallic plans) are available during the special
enrollment period. Closed plans are not available for
new enrollment, except for the addition of eligible
dependents.
030808 (06-2014)
No. Question Answer
5. Is adult dental plan enrollment also limited to the special enrollment period?
Adult dental plans can be purchased at the time of
medical plan enrollment or during an “add-on period.”
Premera has two upcoming “add-on periods” – July 1,
2014 and January 1, 2015. More information about the
July add-on period will be forthcoming.
6. What is a qualifying event and what do my clients need to show to prove they had a qualifying event?
Refer to the qualifying event flyer posted on our
website in the Apply for Coverage section.
7. Can my clients call Customer Service to prove they had a qualifying event?
Your clients will need to email, mail or fax their
supporting documentation. Customer Service cannot
accept verbal proof.
The fax number is 425-918-3378.
Premera Blue Cross
Attn: Producer Support
PO Box 327, MS 194
Seattle WA 98111
8. Can I submit documentation for my clients?
Yes, you can submit documentation for your clients.
You can email Producer Support, fax or mail the
documentation.
The fax number is 425-918-3378.
Premera Blue Cross
Attn: Producer Support
PO Box 327, MS 194
Seattle WA 98111
9. Where can I find out more information about qualifying events?
Refer to the qualifying event flyer posted on our
websites in the Apply for Coverage section.
030808 (06-2014)
No. Question Answer
10. If my client voluntarily drops their COBRA coverage, is that a qualifying event?
Voluntary termination of COBRA is not a qualifying
event. If your clients voluntarily terminate or stop
paying for their COBRA coverage, they must wait for
the next open enrollment period to apply for coverage.
If their former employer discontinues its Group
coverage, and your client no longer has COBRA
coverage, this is a qualifying event.
11. What happens if the contribution costs for the employee or the spouse/dependents on Group coverage are higher than what they were paying before and the member feels they can’t afford to keep their Group plan and want to purchase an Individual plan. Is that a qualifying event?
No, it is not a qualifying event. If they cancel their
coverage, it is considered voluntary termination of
coverage. Voluntary termination of coverage is not a
qualifying event.
12. When do applications and supporting documentation need to be submitted during the special enrollment period?
If the applicant is applying during a special enrollment
period with a qualifying event the application must be
received within 60 days. The effective date is no more
than 60 days after the application is signed.
13. For Medicaid coverage, is there a list of certain plans that qualify for special enrollment?
The loss of eligibility for Medicaid or a public program
providing health benefits is a qualifying event. It is
included on our qualifying events flyer posted online.
14. If my client chooses to leave their job, is this considered a qualifying event?
Yes, this is considered a qualifying event.
15. If my client enrolled on a Group plan loses coverage, because their employer has dropped its plan, is this considered a qualifying event?
Yes, this is considered a qualifying event.
16. If an employer decides to drop Group coverage, is this a qualifying event for the employer?
Yes, this is considered a qualifying event.
17. What options do my clients have if they don’t qualify for coverage during the special enrollment period?
If your clients don’t qualify for special enrollment, they
have to wait for the next open enrollment period.
There are no other exceptions.
030808 (06-2014)
No. Question Answer
18. When is the next open enrollment period for Individual coverage?
The next open enrollment period for Individual
coverage will be November 15, 2014, through February
15, 2015. Open enrollment periods are established by
the Washington Health Benefit Exchange each year.