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New Special Enrollment Confirmation Process Announced

On February 24, 2016, CMS announced a new Special Enrollment Confirmation Process.

Once the new Special Enrollment Confirmation Process is implemented, all consumers applying through the most common HealthCare.gov special enrollment periods (SEPs) will be directed to submit documentation to verify their eligibly to use an SEP. CMS will then review the documents to ensure consumers qualify for an SEP.

On March 4, 2016, CMS updated the Marketplace application by:

  • Adding New Attestation Language: New language requires consumers to attest that they understand they may be asked to provide additional information, including proof of their eligibility for an SEP, and that, if they do not provide proof of eligibility, they may face penalties including the risk of losing their coverage. This box is on the privacy policy page of the application and must be checked prior to proceeding through a new or updated application and entering information that may qualify the consumer for an SEP.
  • Updates to Loss of Minimum Essential Coverage Questions: Both the recent loss of coverage and future loss of coverage questions have been updated to (1) specify that coverage must have been lost within the past 60 days or will be lost within the next 60 days; (2) provide examples of coverage that qualifies as minimum essential coverage (MEC); and (3) provide a link to a help page that provides a thorough discussion and explanation of MEC. In addition, new blue boxes have been added to clarify that losing coverage due to nonpayment of premiums does not qualify as loss of MEC for purposes of qualifying for this SEP.
  • Updates to the Permanent Move Question: The permanent move question has been updated to specify that the move must have occurred within the last 60 days and provide examples of which situations do and do not qualify as a permanent move for purposes of qualifying for this SEP.

Additionally, CMS updated text on the SEP Screener Tool to reflect these application updates. These application updates will be accompanied by other improvements to the SEP application process, which are described here and are part of the new Special Enrollment Confirmation Process.

Refer to this Fact Sheet for further information on how the Special Enrollment Confirmation Process will work and what else CMS is doing to improve the SEP process.

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