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While the country was watching what Congress is doing to repeal and replace the Affordable Care Act with the American Health Care Act, the Department of Health and Human Services was busy issuing new rules that will affect enrollment for individual health insurance policies.

 SEP (Special Enrollment Period) Enrollments Require Documentation Before Coverage Becomes Effective

The rules surrounding Qualifying Events and Special Enrollment Periods have been significantly tightened.  A Qualifying Event is an event that gives you an opportunity to enroll in individual health coverage outside of the Open Enrollment Period.  A common example of a QE is losing your employer health insurance when you leave a job.  All Special Enrollment Periods require documentation be submitted.  If you are enrolling through the Health Insurance Marketplace, it needs to be submitted by uploading the file to your account or by mailing documentation to the service center.  If you are enrolling off-Marketplace, it should be submitted to the carrier you are enrolling in coverage through.  Carriers must now review the documentation of the Qualifying event before they can enroll you in coverage.

 A SEP May Not Allow You to Make a Coverage Change Mid-Year

 New rules from the Department of Health and Human Services limit your ability to change plans during a SEP.  Previously, any significant changes in income or additions of family members (such as the birth of a child) would allow you to make a plan change during the year.  Under the revised HHS rules, those plan changes are restricted to the Open Enrollment Period.

 Unpaid Premiums

 Did you lapse a policy for non-payment?  New rules allow carriers to delay your enrollment into one of their plans – or plans in their organization (think Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan) if you owe premium you didn’t pay during the last 12 months.  They are not required to process your new enrollment until the back premium due is paid.

Open enrollment Period

 The Open Enrollment Period will be shortened significantly for 2018.  While previous Open Enrollment Periods have lasted from November through the end of January, the 2018 OEP will only run from November 1, 2017, until December 15, 2017.  That gives you six fewer weeks to shop and enroll in your 2018 health insurance coverage.

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