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CMS Provides Guidance on New Exchange Special Enrollment Periods, Hardship Exemptions

CMS Bulletin: Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria (May 2, 2014)

Available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf

Visit the Health Care Reform Community on Checkpoint to join the discussion on this development (for Checkpoint subscribers to EBIA’s Health Care Reform manual).

CMS has issued a bulletin with information about new special enrollment periods (SEPs) for individuals enrolling in coverage through federally facilitated Exchanges (FFEs) (state-based Exchanges are encouraged to adopt similar SEPs), and additional hardship exemptions from the individual mandate penalty that are available in both FFEs and state-based Exchanges. Here are highlights:

 

  • SEP for Non-Calendar-Year Renewals. The bulletin describes a 60-day SEP for individuals whose non-calendar-year individual policies come up for renewal outside of the FFE open enrollment period. [EBIA Comment: This SEP is intended to align FFE enrollment periods with required limited open enrollment periods for non-calendar-year plans in the individual market.]
  • Temporary SEP for Individuals Eligible for or Enrolled in COBRA. This special enrollment period, which is available through July 1, 2014, is discussed along with related COBRA developments in a separate article in this week’s EBIA Weekly.
  • Penalty Exemption for Individuals With Coverage as of May 1, 2014. The bulletin provides for a hardship exemption from the individual mandate penalty for months in 2014 prior to the effective date of coverage, if the individual ultimately obtained coverage outside of an FFE or state-based Exchange by May 1, 2014. [EBIA Comment: This penalty exemption is an extension of a comparable exemption issued in October 2013 for all individuals who enrolled through an Exchange anytime during the initial open enrollment period. (See our article.) ]

 

EBIA Comment: While employers are not directly affected by the individual market and individual mandate provisions, it is important to have a general understanding of the enrollment periods and penalty exemptions available to employees and other individuals. CMS has previously issued more comprehensive bulletins describing various HHS-granted SEPs. (See our article.) For more information, see EBIA’s Health Care Reform manual at Sections XXI.A (“Establishment of Exchanges”) and XXIX.D (“Individual Mandate: Exemptions for Certain Individuals”).

Contributing Editors: EBIA Staff.