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Lawmakers’ PPACA exchange looks at special enrollment process

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Managers of one locally-run public health insurance exchange say they think the special enrollment period (SEP) application process there has been relatively clean.

Mila Kofman, the executive director of the District of Columbia Health Benefit Exchange Authority, talked about SEP application verification concerns earlier this month at an exchange board meeting, according to a copy of the meeting minutes posted on the authority’s website.

See also: What are ‘special’ PPACA enrollees REALLY like?

The exchange and many locally run exchanges have let consumers qualify for some types of SEP by “attesting,” or swearing upon penalty of perjury, that they qualify for the SEPs, rather than by requiring the consumers produce documents showing that they qualify.

The D.C. exchange authority, which runs the DC Health Link exchange, gets up to 500 SEP applications per month outside the regular Patient Protection and Affordable Care Act (PPACA) open enrollment period, Kofman said, according to the meeting minutes.

In the past, Kofman said, DC Health Link required documentation for all types of SEPs. Now, she said, the exchange still requires documentation for some types of SEPs, but it allows attestation for others.

Kofman said the exchange staff is developing a software code the exchange can use to break down SEP enrollee data by SEP category, to see, for example, whether consumers who said they qualified for SEPs because they got married look different from those who said they qualified because they had just moved into the district.

But the exchange staff has been working very closely with the exchange plan issuers to look for any patterns of potential abuse, Kofman said.

The exchange now allows the use of attestations for some SEP categories because it never found any problems with the SEP applications, and requiring so much documentation created burdens for the exchange, Kofman said.

The District of Columbia requires sales of all individual health policies to go through the exchange. The Patient Protection and Affordable Care Act (PPACA) requires members of Congress and many lawmakers’ aides to get their own health coverage through the PPACA exchange system.

The U.S. Office of Personnel Management (OPM) lets the lawmakers and aides affected by that requirement get their health benefits from the DC Health Link Small Business Health Options Program (SHOP) division.

Regulators, health insurers and exchanges use an annual “open enrollment period” system, or limits on when people can buy coverage without applying for an exemption from the limits, to try to keep healthy people from waiting until they get sick to pay for coverage.

The third PPACA open enrollment period, which was for 2016 coverage, started Nov. 1 and ended Jan. 31 in most of the country. 

See also: 

Watchdogs: PPACA exchanges had lousy walls in 2014

Lawmakers’ exchange pans enrollment proposal


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