Dive Brief:
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In response to pressure from health insurers, CMS has announced its plans for tightening controls on special enrollment opportunities to prevent consumers from waiting until their sick to buy plans and then dropping them soon after.
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The changes eliminate unnecessary special enrollment periods, clarify the definitions of others, and provide enforcement of the guidelines "so that special enrollment periods serve the purpose for which they are intended and do not provide unintended loopholes," stated a CMS blog post by Health Insurance Marketplace CEO Kevin Counihan.
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The post adds CMS will emphasize to consumers they are subject to penalties under federal law if they purposely provide false information to the marketplace.
Dive Insight:
Insurers expect the tighter restrictions to special enrollment to help stabilize premiums for consumers and to balance the risk pool for issuers, which are necessary to encourage consumer and issuer participation, as the Blue Cross Blue Shield Association wrote in a December comment letter to CMS and shared with Healthcare Dive.
The CMS blog describes the following changes:
- The elimination of "unnecessary" special enrollment periods including tax season special enrollment and six others the agency says are no longer needed for issues around redundant policies, system errors, processing delays, and eligibility or enrollment in COBRA or the Pre-Existing Condition Health Insurance Program.
- The clarification of eligibility to educate consumers, brokers, and issuers on the intent of the rules and to discourage mis-use, including guidance on special enrollment periods for consumers who have permanently moved vs. temporarily moved.
- The enforcement of the rules via an assessment of special enrollments to ennsure the consumers were properly qualified.
Additional details will be released in the coming weeks, Counihan wrote.