Plan Verification and Fairness Act of 2016

To amend title I of the Patient Protection and Affordable Care Act to require verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans, and for other purposes. 1. Short title This Act may be cited as the Plan Verification and Fairness Act of 2016 2. Requiring verification for eligibility for enrollment during special enrollment periods in PPACA insurance plans (a) In general Section 1311(c) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(c) (7) Verification requirement for special enrollment periods (A) In general The Secretary shall provide that, in the case of a special enrollment period provided for under paragraph (6)(C) that is with respect to a plan year that begins on or after January 1, 2017, qualified health plans offered through an Exchange may not make coverage effective with respect to an individual enrolling during such period until the Exchange verifies, through an approved ver­i­fi­ca­tion process described in subparagraph (B), that the individual, with respect to such Exchange, is a qualified individual who is eligible to enroll during such period. (B) Approved verification process described For purposes of subparagraph (A), an approved verification process described in this subparagraph is a process specified by the Secretary through interim final rulemaking that requires an individual described in subparagraph (A) seeking to enroll in a qualified health plan described in such subparagraph to submit to the Exchange such documents as the Secretary determines are necessary in order for the Exchange to verify that the individual, with respect to such Exchange, is a qualified individual who is eligible to enroll during a period described in such subparagraph. To the extent practicable, such process shall be similar to the review and assessment process pertaining to special enrollment periods described at 81 Fed. Reg. 12274 in the final rule entitled Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017 . (b) Study and report (1) Study The Inspector General of the Department of Health and Human Services shall conduct a study on enrollment by individuals in qualified health plans (as defined in section 1301(a) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18021(a) 42 U.S.C. 18031(c)(6)(C) (A) The number of individuals who sought to enroll in such a plan through an Exchange established under such Act during such period but who were not allowed to so enroll during such period. (B) The number of such individuals who were not allowed to so enroll through such an Exchange during such period on account of each of the following: (i) The individual did not provide to the Exchange documentation to demonstrate that the individual was, with respect to the Exchange, a qualified individual (as defined in section 1312(f)(1) of such Act ( 42 U.S.C. 18032(f)(1) (ii) Such documentation provided to the Exchange by the individual was invalid. (2) Report Not later than June 1, 2017, such Inspector General shall submit to Congress a report on the findings of the study conducted under paragraph (1).

Summary: Plan Verification and Fairness Act of 2016 This bill amends the Patient Protection and Affordable Care Act to require health insurance exchanges to verify an individual's eligibility for a special enrollment period before coverage is made effective. Individuals seeking coverage through an exchange during a special enrollment period must submit to the exchange the documents necessary to verify their eligibility for the special enrollment period. The Office of the Inspector General of the Department of Health and Human Services must report on enrollment during special enrollment periods for plan year 2015. The report must include the number of individuals who: (1) sought to enroll during a special enrollment period but were prohibited, (2) were prohibited because they did not provide documentation supporting eligibility, and (3) were prohibited because they provided invalid documentation.