The CMS posted a slide presentation, "Change in Circumstances (CiC) Interim Functionality Update" for a Jan. 23 webinar for health insurers that sell qualified health plans (QHPs) on HealthCare.gov.
The presentation outlines the process for people to make changes when they have life events for which they would have to change health plans or for which their eligibility for financial assistance under the ACA changes.
The presentation says that consumers will need to submit a new application to replace the original application, so that eligibility can be redetermined for everyone on the new application. The federally facilitated marketplace will determine eligibility for a special enrollment period and permit eligible consumers to select a new plan.
Life events resulting in a special enrollment period eligibility are:
- Adding a member, such as a birth or by marriage;
- Losing access to other coverage, such as employer coverage;
- Being released from incarceration; and
- Changing citizenship or immigration status.
The presentation also listed life events that don't result in special enrollment period eligibility:
- Removing a member as a result of death or divorce;
- Gaining access to other coverage, such as employer coverage;
- Becoming pregnant;
- A change in tax filing status;
- A change in status as American Indians, Alaska Natives or tribal status;
- Changes in disability status;
- Corrections to date or birth or Social Security number, or;
- Some changes in income.
If a new plan is selected, consumers will be terminated from their original plan and enrolled in the new plan with no gap in coverage, it said. Consumers who don't qualify for a special enrollment period won't be permitted to change plans, but will re-select the original plan with updated information, it said.