Register now to attend our fall agent seminars
We look forward to seeing you in person at our agent seminars this fall. Meetings will include updates for our Individual and Small Employer plans. Idaho and Colorado Agent Seminars will also include Medicare plan information. RSVP to these events here. Stay tuned for information on the availability for flu shots and CE credit as part of our meetings. Once registered, you’ll receive updates through email.
Individual plans – Dual Enrollment FFM and Medicaid
Select Health has identified a substantial increase in members who have obtained inappropriate dual coverage involving a subsidized Federally Facilitated Marketplace (FFM) plan and Medicaid enrollment. We want to remind agents that as a licensed and appointed insurance agent, you have an obligation to validate any current or past insurance coverage for clients to prevent inappropriate enrollments (dual subsidized plans) from occurring. If an application is accurately completed and Medicaid coverage is active, a subsidy will not be awarded to an individual covered by Medicaid.
Based on input from Marketplace contacts, the following consequences may occur if dual coverage is discovered:
- Members may be financially responsible for all subsidy amounts paid by the Marketplace while having dual coverage and may be responsible for the entire premium amount with no subsidy assistance moving forward.
- Members found with active Medicaid coverage not being disclosed on the Marketplace application are subject to policy rescission, which could result in Select Health retracting all dollars paid on claims processed for the client under the rescinded policy.
Select Health is providing education and outreach on this issue to prevent further dual enrollments between Marketplace and Medicaid coverage to protect our members and your clients. It is the agent’s responsibility to perform their due diligence and validate active Medicaid coverage at the time of application. Verification includes requiring proof of Medicaid denial or termination. Verification of loss of coverage is imperative to confidently answering all enrollment questions and completing a Marketplace application in an accurate and ethical manner.
If an agent identifies dual coverage, the agent and client should report the issue to the Marketplace to resolve the issue.
Below are links to resources that outline how clients should report obtaining newly awarded and currently active Medicaid coverage:
If you have questions or concerns about an enrollment, please reach out to the Marketplace or our sales team.
Individual plans – Consent to Assist form
As part of the Notice of Benefit and Payment Parameters (NBPP) of 2024, agents helping consumers enroll in Marketplace coverage or apply for Advance Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR) for Qualified Health Plans (QHP) through the Federally-facilitated Exchange (FFE) or State-based Exchange (SBE), are now required to document receipt of consent from the consumer or an authorized representative for the consumer. Certain elements are required for consent. Additional information and a sample form are available from CMS at the following links:
For your information, this policy went into effect June 18, 2023.
Small employer group terminations
Termination must be submitted no later than the last day of the month the employer desires coverage to end. We will not retroactively terminate Small Employer groups. Please note, terminating all employees does not terminate the group in the system and could generate a premium payment draft. A group termination needs to be submitted in Link. From the Employer Summary page, select Terminate Group/Subgroup in red.
Questions? Contact your account manager or call Small Employer Sales at 800-442-5306, option 2.