Legislative Update – March 2016

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CMS has addressed carriers concerns about the lack of oversight regarding ACA applications they receive during SEP. In 2015 and prior CMS has relied on the honor system and therefore there has been little oversight of applicants claiming a qualifying event. CMS has eliminated six (obscure and rarely used) qualifying events, and will now require an applicant to provide documentation of the qualifying event being used during SEP. 

Dates for the ACA Open Enrollment for 2017 and 2018 will remain as is, running from Nov 1st until Jan 31st. However, starting in 2019 and each year thereafter, the open enrollment will be shortened to 45 days, starting Nov 1st and ending Dec. 15th.

One other recent announcement from CMS is the Out of Pocket max limits for 2017. The limits have been set at $7150 Individual and $14,300 Family.  

Lastly, CMS released guidance on “Grandmothered” plans, which are due to terminate in Oct 2017. Each state will now have the option to allow these plans to be extended thru Dec 31st, 2017. Most states will likely exercise this option to avoid the obvious disruption caused by a policy being cancelled with three months left in the year.

Dale Mason
FWAHU Legislative Chair

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