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j_hce_2016a_2016-08-24t09:03:13z0 Hearing Summary

Date: 08/24/2016


Discussion with Connect for Health of Previously Raised Questions


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09:03 AM -- Discussion with Connect for Health of Previously Raised Questions

Kevin Patterson, Chief Executive Officer, Connect for Health Colorado, provided a handout to the committee outlining his presentation on Connect for Health Colorado's response to questions about special enrollment periods (SEP) that were asked at the August 2, 2016, meeting (Attachment B). He explained the procedures and requirements for SEP. He told the committee that there is a national discussion around whether the federal marketplace and state-based exchanges should verify SEPs more aggressively. He explained that insurance carriers report that individuals who enroll in coverage using a SEP often have higher claims and many carriers believe that there is some misrepresentation on the part of these individuals about the circumstances that allow them to enroll using a SEP. Currently, the customer's attestation on the application for coverage that he or she qualifies for a SEP is the only verification required. Mr. Patterson explained that SEP verification could be accomplished in a variety of ways including: the exchange verifying documentation provided by all customers or verifying documentation provided by a subset of customers, or carriers verifying the documentation. In response to committee questions, Mr. Patterson stated that pregnancy is not currently considered as a triggering event for a SEP and only New York permits pregnancy to be considered for SEP purposes. Mr. Patterson responded to additional questions from the committee about SEP.

160824 AttachB.pdf160824 AttachB.pdf

09:16 AM

Committee discussion followed regarding consumers transitioning off of Medicaid and then looking for coverage through the exchange. Mr. Patterson discussed supports that are in place to help consumers utilize the exchange, such as certified application centers. Mr. Patterson clarified that consumers who seek insurance coverage after a SEP qualifying event are covered by the new insurance from the date of the qualifying event as long as the new insurance is purchased within 90 days.