Tuesday, July 11, 2017

SEP News (Sorta)

As we've previously noted, the qualification process for triggering a Special Open Enrollment has gotten tougher, as carriers have been hit with ever higher claims:

"Perhaps the most egregious is the fact that no one in government seems to care about the massive fraud being perpetrated right under their noses during this time."

Our friends at Medical Mutual emailed us a slideshow of the new, tougher Special Open Enrollment process, available here.

One that immediately jumped out was this:

"Beginning in Summer 2017, new applicants ... who attest to certain types of SEP qualifying events will be subject to the SEPV process of pre-enrollment verification. Eligible consumers must submit documents that confirm their SEP eligibility before they can enroll and start using their Marketplace coverage."
Quite different than before, where one was given a certain period of time after enrolling in (and, perhaps, using) a new plan. Under the new system, no policy is issued until the verification paperwork is submitted and approved.

Which would seem to be a challenge for carriers, but fret not:

"When submitting business ON Exchange please submit verification documents directly to the exchange.  Medical Mutual cannot process/accept anything that is submitted directly to us."

Can't say as I blame them. 

NB: I reached out to our rep who confirmed that MMO would continue to process this info for off-HIX plans.
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