The Centers for Medicaid and Medicare Services (CMS) have revised the requirements for purchasing health insurance during a special enrollment period. Beginning June 23, 2017 pre-enrollment verification starts for special enrollments due to loss of coverage or a move. The new process for enrolling in health insurance during a Special Enrollment Period requires pre-enrollment verification which CMS has termed SEPV. This means that consumers will need to submit documents verifying they qualify prior to receiving coverage.
An SVI (SEP Verification Issue) will be created at the beginning of the enrollment process. Once the SVI is created you have 30 days to provide documentation and choose your plan before your SVI is canceled and then you will have to wait until the next open enrollment window (Nov 1- Dec 15) before you can enroll in a health plan. In August, CMS will release the new action steps for consumers seeking special enrollment due to marriage; gaining or losing a dependent due to adoption, foster care, child support, or court order.
The New Pre-enrollment Verification SEPV Process
The new process sounds complicated, but when you break it down, it is pretty straightforward.
- Submit an application for Special Enrollment Period (SEP). Your application will create an SVI (Verification Issue) in the system.
- Select a plan. If you need help searching plans Take Command Health can help you search the best options in your area. Plan Enrollment is on hold until you provide further documentation. You have 30 days to complete process.
- Mail in or upload documents providing proof of either your move or loss of coverage. If you need to enroll multiple members of a household, you will only need to provide documentation for one of the members and this will provide proof for the entire family. Note: If you enroll through Take Command Health, we'll help you get these documents together and submit with your application on our electronic platform.
- Marketplace reviews your documents and may request additional proof.
- Marketplace approves the SVI and sends you plan enrollment paperwork.
- Submit payment to activate and begin using your new plan! Congratulations!
Providing proof of qualification is fairly easy. For loss of coverage you can apply either 60 days in advance of losing coverage (so you have no gaps in insurance) or 60 days after losing coverage. A letter from the insurance provider stating who is losing coverage and the effective date is required.
For those that have moved, you have 60 days after the move to enroll in a new plan. In addition to providing proof of the move, such as a bill or change of address from post office, you will also need to provide proof of health insurance coverage for at least 1 of the 60 days prior.
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I wrote this blog because I love helping people decode confusing insurance jargon and understand the fine print. I'm a licensed health insurance professional and specialize in simplifying health insurance for individuals and small businesses. My QSEHRA articles have been featured regularly on Accounting Today, Accounting Web, HRWeb, and other industry publications. I'm also a member of Take Command Health's client success team and a full-time mom. Learn more about me and connect with me on our about us page. Thanks!