The Centers for Medicare and Medicare Services (CMS) has announced special provisions for the Carolinas and Virginia. In response to Hurricane Florence, a special public health emergency declaration is in effect for these three states. Special Enrollment Opportunities for hurricane victims are extending for those who qualify to ensure they complete their ACA Marketplace enrollment.
Due to the storm, The Federal-facilitated Marketplace (FFM) is creating an Exceptional Circumstances Special Enrollment Period for those affected by the hurricane. Normally your ACA clients are only able to enroll in the ACA marketplace during the Open Enrollment Period (OEP) or if they qualify for a special enrollment period (SEP). These include such things as birth, marriage, relocation, etc. However, those affected by an emergency or major disaster recognized by FEMA now qualify for an extension of the Special Enrollment Period.
For instance, if your ACA client qualified for a Special Enrollment Period on August 1st and started the enrollment process but a disaster declaration went out in their state on September 13th preventing you from helping your clients enroll during this period, they are considered qualified for an SEP. Individuals will be considered for an Exceptional Circumstances SEP if they are unable to enroll in the enrollment period in which they were previously eligible due to the disaster declaration. Clients will be required to attest to the fact that they were affected; One, they have to prove they reside in any counties that are eligible to apply for individual or public assistance by FEMA, and two, they were affected by the emergency that prevented them from completing their ACA enrollment.
Individuals affected will have a maximum of 60 days to enroll and select a new qualifying health plan through the ACA Marketplace. Your ACA clients can choose to have coverage start in the future or request the effective date they would have received if a plan was selected during their original ACA enrollment opportunity, or on or after the FEMA-designated incident start date. Effective date rules on coverage vary based on the date of the plan selection and the qualifying event.
To request an Exceptional Circumstances SEP, affected individuals must contact the Marketplace Call Center at 1-800-318-2596 or TTY at 1-855-889-4325 and state they are eligible for another enrollment window due to a FEMA-designated emergency. For more information on assisting your ACA clients eligible in the Carolinas and Virginia for an SEP, please contact Agent Pipeline ACA Experts at 800-962-4693.
Source: Consumer Information Insurance Oversight. (n.d.). Retrieved from https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/8-9-natural-disaster-SEP.pdf