The U.S. Department of Health and Human Services (HHS) recently released an Interim Final Rule that formally extends some of the marketplace (also known as the exchange) deadlines and encourages insurers to provide additional extensions if possible.
Extensions Affecting the Federally-Facilitated Small Business Health Options Program (FF-SHOP) Marketplace
The rule reiterates that employers and individuals may enroll in the FF-SHOP marketplace as late as December 23, 2013, and still have coverage as of January 1, 2014. (The employer must select a SHOP plan, or meet other insurer requirements to indicate it wishes to purchase SHOP coverage, and provide enrollment forms for employees seeking coverage to the insurer no later than December 23.) Insurers also may accept applications for January 2014 coverage throughout the month of January if they wish.
This extended enrollment date only applies to the FF-SHOP marketplace. However, if an insurer wishes to extend the deadline to December 23, 2013, for applying for small group coverage outside the marketplace (rather than enforcing the current December 15, 2013, deadline) to be consistent both inside and outside the marketplace, it has that option.
Insurers must allow premiums to be paid as late as December 31, 2013, for coverage beginning January 1, 2014. Insurers are encouraged, but not required, to accept premiums for coverage at any time during the month of January for coverage that is effective January 1, 2014. Insurers may, if they wish, accept partial premium payments at thresholds determined by the insurer. The Association of Health Insurance Plans (AHIP) has announced that most insurers will accept premiums until January 10, 2014, for coverage effective January 1, 2014.
HHS has also clarified in an FAQ that an insurer may not impose minimum participation requirements on renewals occurring during the November 15 through December 15 open enrollment period for the FF SHOP.
Extensions Affecting the State-Run Small Business Health Options Program (State SHOP) Marketplace
The rule provides that state SHOPs may still require individuals to enroll by December 15, 2013, to have coverage as of January 1, 2014. However, state SHOPs also have the option to extend enrollment, even past December 23, 2013, if they wish. Insurers must allow premiums to be paid as late as December 31, 2013, for coverage beginning January 1, 2014, and insurers are encouraged to accept premiums for coverage at any time during the month of January for coverage that is effective January 1, 2014. Insurers may, if they wish, accept partial premium payments at thresholds determined by the insurer. The AHIP has announced that most insurers will accept premiums until January 10, 2014, for coverage effective January 1, 2014. Several states have announced slightly different premium due dates.
The SHOP has been delayed in several states. In those states, according to an HHS FAQ, minimum participation requirements may not be imposed for coverage commencing in 2014, because there was no open enrollment available during the period of November 15, 2013, through December 15, 2013.
Extensions Affecting the Federally-Facilitated Individual (FF-E) Marketplace
The rule reiterates that individuals may enroll in the marketplace as late as December 23, 2013, and still have coverage as of January 1, 2014. This extended enrollment date only applies to the marketplace. However, if an insurer wishes to extend the deadline to December 23, 2013, for applying for individual coverage outside the marketplace (rather than enforcing the current December 15, 2013, deadline), it has that option.
Insurers must allow premiums to be paid as late as December 31, 2013, for coverage beginning January 1, 2014. Insurers must set a premium due date for January 2014 coverage (which cannot be earlier than December 31, 2013); they are encouraged, but not required, to accept premiums for coverage at any time during the month of January for coverage that is effective January 1, 2014. Insurers may, if they wish, accept partial premium payments at thresholds determined by the insurer. The AHIP has announced that most insurers will accept premiums until January 10, 2014, for coverage effective January 1, 2014.
Extensions Affecting the State Individual Marketplace
The rule reiterates that individuals may enroll in the marketplace as late as December 23, 2013, and still have coverage as of January 1, 2014. In addition, state marketplaces have the option to extend enrollment, even past December 23, 2013, if they wish. Insurers must allow premiums to be paid as late as December 31, 2013, for coverage beginning January 1, 2014. State exchanges may establish payment cut-off dates that are the same as, or different from, those in the FF-E. Insurers may, if they wish, accept partial premium payments at thresholds determined by the insurer and consistent with state law. The AHIP has announced that most insurers are willing to accept premiums until January 10, 2014, for coverage effective January 1, 2014. Several states have announced slightly different premium due dates.
This extended enrollment date only applies to the marketplace. However, if an insurer wishes to extend the deadline to December 23, 2013, for applying for individual coverage outside the marketplace (rather than enforcing the current December 15, 2013, deadline), it has that option.
If you would like more information on the Marketplace (Exchange) please request it here.
