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Life Health > Health Insurance

New exchange screening rules slash sales

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The new federal special enrollment period eligibility screening rules introduced earlier this year have cut plan sales about 15 percent, exchange managers say.

Related: posts excuse documentation lists for off-season shoppers managers will introduce a new special enrollment period eligibility verification pilot program after the end of the 2017 open enrollment period, which is set to run from Nov. 1 through Jan. 31, officials say.

Officials at the Centers for Medicare & Medicaid Services (CMS), the arm of the U.S. Department of Health and Human Services that runs, talk about the drop in sales and the new pilot program in a new set of answers to frequently asked questions posted on the CMS website.

CMS wants to see if the pilot program can chase away fraudulent special enrollment period applicants while easing the application process for consumers who do qualify for special enrollment periods, officials say.

CMS is asking for public comments about how it should design the pilot program.

HHS created to provide Affordable Care Act exchange administration services in states that are unwilling or unable to do the job themselves.

The ACA prohibits insurers from consider personal health status factors other than location when selling individual major medical coverage, or factors other than location, age or tobacco use when setting major medical coverage prices.

Insurance regulators, insurers and exchange program managers established the ACA “open enrollment period” system, or limits on when consumers can buy health coverage without showing they have what the government considers to be a good reason for shopping for coverage, to keep healthy consumers from waiting until they get sick to pay for coverage.

During the rest of the year, consumers have to show they are eligible for a special enrollment period to get covered.

In the past, users could qualify for some special enrollment periods, such as getting a special enrollment based on moving to a new community, by simply telling they qualified for the special enrollment period.

Last year and earlier this year, insurers complained bitterly about their belief that many special enrollment period applicants were lying about eligibility.

In California, a state with a state-based exchange, Covered California, insurers told the Covered California board that imposing special enrollment period verification requirements in the off-exchange market reduced special enrollment period application volume by 15 percent to 35 percent. Insurers gave that finding as evidence that many consumers had been filing fraudulent SEP applications.

Consumer group representatives argue that few consumers understand the special enrollment period process, and that the verification-related drop in special enrollment period application volume was the result of consumers’ inability to cope with the documentation requirements, not fraud.


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