January 17, 2014

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Federal Subsidies Survive First Round of Lawsuits
Congress Back in Action
On the Hill Again
Let’s Talk About Risk, Baby
CMS Issues Clarification on Special Enrollment Periods and Hardship Exemptions
Local Help on Healthcare.gov Now Includes Agent and Broker Information
Exchange Watch: Texas and Oregon
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CMS Issues Clarification on Special Enrollment Periods and Hardship Exemptions

The Department of Health and Human Services has certainly received a ton of questions about President Obama’s signature health reform law and while we still have several outstanding questions, HHS was able to clarify when consumers actually qualify for a special enrollment period over a hardship exemption. This clarification comes in response to an influx of questions from agents and brokers requesting hardship exemptions for their clients but, according to HHS, in many cases, consumers seeking hardship exemptions actually qualify for a special enrollment period. Here’s how HHS has distinguished between the two:

“Hardship Exemptions – The ACA recognizes that individuals with a hardship making it difficult to afford coverage with comprehensive benefits may qualify for a “hardship” exemption from the individual responsibility requirement. Individuals who qualify for such an exemption may also be able to purchase catastrophic coverage on the Marketplace. A complete listing of circumstances that might qualify an individual for a 'hardship' exemption is available at this link: https://www.healthcare.gov/exemptions/. Information on how to apply for a hardship exemption is available at this link: http://marketplace.cms.gov/getofficialresources/publications-and-articles/hardship-exemption.pdf.

Special Enrollment Periods – The ACA and Exchange final regulations permit consumers to be granted an SEP for specific situations. As of January 1, 2014, individuals who contact CMS stating that they have evidence of an attempt to complete the enrollment process within the enrollment deadlines, believed they had enrolled in coverage for a January 1st effective date but were not enrolled in the QHP because of incorrect enrollment data transmitted by the FFM to the issuer, may qualify for a special enrollment period with coverage retroactive to January 1st. To qualify for this SEP, the individual will need to provide an attestation and proof that he or she completed the steps to enroll in a QHP. We note that consumers who cannot provide proof of completion of the enrollment process by the enrollment deadline will receive coverage for a February 1st or otherwise applicable effective date.

We recognize that agents and brokers are working closely with their clients to enroll in coverage, and want to make sure they are aware of the distinction between the hardship exemption and this type of SEP."

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