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PPACA plans lurch toward servicing stage

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Any brokers who are still trying to help consumers use the public exchanges are thinking more about what they will do while the plan year is underway.

The PPACA exchange open enrollment period for individual QHP coverage started Oct. 1 and officially ended yesterday in most of the country.

Many exchange producers — and navigators, certified application counselors and other exchange helpers — continue to struggle to get consumers’ Patient Protection and Affordable Care Act “qualified health plan” applications through glitch-plagued websites and overwhelmed manual processing systems.

One of the first post-enrollment-period jobs will be helping would-be QHP enrollees use the unofficial two-week enrollment deadline extensions available to most enrollees in most of the country.

The second job will be to help consumers who fail to “get covered” by April 15 to use a formal process to apply for 60-day “special enrollment periods.”

Consumers can qualify for special enrollment periods for many reasons, ranging from having a “qualifying life event,” such as getting married, to suffering from exchange helper errors.

A Web broker, eHealth Inc., is courting consumers in the “missed the deadline” market with a national press release that describes the resources it can offer the still-uninsured, including a telephone hotline for the uninsured, a brief description of the special enrollment period system, and a list of major medical alternatives, such as short-term health insurance and accident insurance.

The Centers for Medicare & Medicaid Services, the U.S. Department of Health and Human Services agency that manages the 37 HHS-run exchanges, is also starting to post guides explaining what QHP have to do while the plan year is under way. 

“Life changes” reporting could be a big job.

QHP enrollees are supposed to report life changes such as getting married, having a change in disability status, or gaining or losing a dependent whenever the changes occur, according to a CMS life changes reporting guide.

QHP enrollees are supposed to tell the exchange about types of life changes that some consumers might prefer to keep to themselves. Some women, for example, may prefer to stay quiet about pregnancies until babies are visibly on the way. But one of the life changes exchange users have to report is becoming pregnant.

Enrollees may also need help with canceling QHP coverage, changing QHPs and terminating QHP coverage. 

“Consumers may voluntarily terminate their enrollment upon request for any reason,” according to a CMS QHP coverage change guide for assisters.

Consumers can change QHPs during the enrollment season hiatus if they qualify for special enrollment periods, officials said.

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