Trump administration officials have published a new guide for agents and brokers who help consumers apply for health coverage through the new HealthCare.gov special enrollment period process.
The Centers for Medicare & Medicaid Services recently responded to insurer concerns about SEP fraud by requiring just about all applicants for SEPs to document their need for a SEP. CMS has added a link to a major new section on the SEP documentation requirements to the front page HealthCare.gov website.
In the new guide, officials give detailed examples of what kinds of consumers qualify to buy health coverage through a SEP and which do not.
Consumers who have lost employer coverage, moved or enrolled in a plan that violates a major contract provision can qualify for SEPs, officials say.
Voluntarily dropping other coverage, being terminated from other coverage for failure to pay the premium bills, and being terminated from other coverage for fraud are not reasons that qualify a consumer for a SEP, officials say.
“Moving only for medical treatment or staying somewhere for vacation doesn’t qualify consumers for a SEP,” officials say, several times.