Source: https://individuals.healthreformquotes.com/open-enrollment-for-individuals-families/ccr-code-regulations-ca-%C2%A76504-special-enrollment-periods/special-enrollment-triggering-events/zspecial-enrollment-pre-4-2017-cms-9929-f-historical/donald-care-pending-changes-special-enrollment/promote-continuous-coverage-4-18-2017-cfr-amendments/
Timestamp: 2019-07-16 10:30:07
Document Index: 504367198

Matched Legal Cases: ['§6504', '§155', '§156', '§155', '§155', '§155', '§155', '§155', '§155']

Promote Continuous Coverage - 4.18.2017 - CFR Amendments | Health Plans for Individuals & Families Promote Continuous Coverage - 4.18.2017 - CFR Amendments | Health Plans for Individuals & Families
Home › Open Enrollment & Special Enrollment › §6504 Special Enrollment Periods CCR California Code of Regulations › CFR §155.420 Federal Qualifying Events, Triggers › zSpecial Enrollment pre-4.2017 * CMS 9929 F * Historical › Special Enrollment Changes Donald Care CMS 9929 F › Promote Continuous Coverage – 4.18.2017 – CFR Amendments
CFR Promote Continous Coverage CMS 9929 F
New CFR Rule to encourage no lapsing of Coverage and then re-enrolling when one gets sick
The final rule promotes personal responsibility by allowing issuers to require individuals to pay back past due premiums before enrolling into a plan with the same issuer the following year. This is intended to address gaming and encourage individuals to maintain continuous coverage throughout the year, which will have a positive impact on the risk pool.
We believe this interpretation will have a positive impact on the risk pool by removing economic incentives individuals may have had to pay premiums only when they were in need of healthcare services, particularly toward the end of the benefit year. Final Rule Page 4
See also AHCA 30% penalty for letting coverage lapse Section 133
USPS log of all mail sent to you. Prove you never got a late or cancellation notice! ???
We are finalizing this proposal as follows.
To the extent permitted by applicable State law,
Kaiser Health News 10.31.2017 *
an issuer may attribute to any past-due premium amounts owed to that issuer the initial premium payment made in accordance with the terms of the health insurance policy to effectuate coverage.
If the issuer is a member of a controlled group, the issuer may attribute any past-due premium amounts owed to any other issuer that is a member of such controlled group, for coverage in the 12-month period preceding the effective date of the new coverage when determining whether an individual or employer has made an initial premium payment to effectuate new coverage. Consistent with the scope of the guaranteed availability provision [147.104] and subject to applicable State law, this policy applies both inside and outside of the Exchanges in the individual, small group, and large group markets, and during applicable open enrollment or special enrollment periods. This policy does not permit a different issuer (other than one in the same controlled group as the issuer to which past-due premiums are owed) to condition the effectuation of new coverage on payment of past-due premiums or permit any issuer to condition the effectuation of new coverage on payment of past-due premiums by any individual other than the person contractually responsible for the payment of premiums.
As further described later in this preamble, for this purpose, the term controlled group means a group of two or more persons that is treated as a single employer under sections 52(a), 52(b), 414(m), or 414(o) of the Code. We also specify that issuers adopting this premium payment policy, as well as any issuers that do not adopt the policy but are within an adopting issuer’s controlled group, must clearly describe in any enrollment application materials, and in any notice that is provided regarding non-payment of premiums, in paper or electronic form, the consequences of non-payment on future enrollment.
We encourage States to adopt a similar approach; however, States may narrow the circumstances and conditions under which an issuer may apply a premium payment policy to past-due premiums before effectuating coverage or may prohibit the practice altogether. The following is a summary of the public comments we received on this proposal, and our responses. CMS 9929 F Page 18
Link to an amendment published at 82 FR 18381, Apr. 18, 2017.
(1) Open enrollment periods—
(i) Group market.
(A) Subject to paragraph (b)(1)(i)(B) of this section, a health insurance issuer in the group market must allow an employer to purchase health insurance coverage for a group health plan at any point during the year.
(B) In the case of a group health plan in the small group market that cannot comply with employer contribution or group participation rules for the offering of health insurance coverage, as allowed under applicable State law and in the case of a QHP offered in the SHOP, as permitted by §156.285(e) of this subchapter, a health insurance issuer may restrict the availability of coverage to an annual enrollment period that begins November 15 and extends through December 15 of each calendar year.
(C) With respect to coverage in the small group market, and in the large group market if such coverage is offered through a Small Business Health Options Program (SHOP) in a State, coverage must become effective consistent with the dates described in §155.725 of this subchapter, except as provided in paragraph (b)(1)(iii) of this section.
(ii) Individual market. A health insurance issuer in the individual market must allow an individual to purchase health insurance coverage during the initial and annual open enrollment periods described in §155.410(b) and (e) of this subchapter. Coverage must become effective consistent with the dates described in §155.410(c) and (f) of this subchapter, except as provided in paragraph (b)(1)(iii) of this section.
(iii) Exception in certain effective dates of coverage. Only with respect to coverage offered outside of an Exchange or SHOP, for a plan selection received by an issuer on or before December 15, 2013, the issuer must ensure a coverage effective date of January 1, 2014, and for a plan selection received by an issuer between the 16th and 31st of the month of December 2013, an issuer generally must ensure a coverage effective date of February 1, 2014. The preceding sentence does not prevent an issuer from aligning the plan selection and coverage effective dates with those required by the Exchange or SHOP, as applicable, in the applicable state, consistent with §155.410(c) of this subchapter.
(2) Limited open enrollment periods.
(i) A health insurance issuer in the individual market must provide a limited open enrollment period [Special Enrollment?] for the triggering events described in §155.420(d) of this subchapter, excluding the following:
(ii) In applying this paragraph (b)(2), a reference in §155.420 of this subchapter to a “QHP” is deemed to refer to a plan, a reference to “the Exchange” is deemed to refer to the applicable State authority, and a reference to a “qualified individual” is deemed to refer to an individual in the individual market.
(4) Length of enrollment periods.
(i) In the group market, enrollees must be provided 30 calendar days after the date of the qualifying event described in paragraph (b)(3) of this section to elect coverage.
(c) Special rules for network plans.
(1) In the case of a health insurance issuer that offers health insurance coverage in the group and individual market through a network plan, the issuer may do the following:
(2) An issuer that denies health insurance coverage to an individual or an employer in any service area, in accordance with paragraph (c)(1)(ii) of this section, may not offer coverage in the individual, small group, or large group market, as applicable, for a period of 180 calendar days after the date the coverage is denied. This paragraph (c)(2) does not limit the issuer’s ability to renew coverage already in force or relieve the issuer of the responsibility to renew that coverage.
(1) A health insurance issuer may deny health insurance coverage in the group or individual market if the issuer has demonstrated to the applicable state authority (if required by the state authority) the following:
(3) Paragraph (d)(2) of this section does not limit the issuer’s ability to renew coverage already in force or relieve the issuer of the responsibility to renew that coverage.
[78 FR 13437, Feb. 27, 2013, as amended at 78 FR 65092, Oct. 30, 2013; 78 FR 76217, Dec. 17, 2013; 79 FR 30339, May 27, 2014; 79 FR 59138, Oct. 1, 2014; 80 FR 10862, Feb. 27, 2015; 81 FR 94173, Dec. 22, 2016]