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Small Business Employee Benefits and HR Blog

HHS Releases Interim Final Rule on Deadlines for Marketplace Coverage

On December 12, 2013, the U.S. Department of Health and Human Services (HHS) released an Interim Final Rule that formally extends some of the health insurance exchange (aka "marketplace") deadlines and encourages insurers to provide additional extensions, if possible. 

Deadlines for Marketplace CoverageInterim Final Rule on Deadlines for Marketplace Coverage

Here is a summary of the Interim Final Rule, and how it impacts individual marketplace coverage, SHOP marketplace coverage, and insurers.

Deadlines and Extensions for Individual Marketplace Coverage

The Interim Final Rule extends the enrollment deadline for January 1, 2014 individual marketplace coverage to December 23, 2013.

Deadlines and Extensions for Small Business SHOP Marketplace Coverage

The Interim Final Rule extends the enrollment deadline for January 1, 2014 SHOP coverage to December 23, 2013 (for the federally-run SHOP marketplaces).

HHS has also clarified in an FAQ that an insurer may not impose minimum participation requirements on renewals occurring during the November 15 through December 15 open enrollment period for the federally-run SHOP marketplace.

Deadlines and Extensions for Insurers

The Interim Final Rule requires issuers of Qualified Health Plans on the federally-run marketplace to set an initial premium payment cut-off date of no earlier than December 31, 2013 - for coverage effective January 1, 2014.

The Interim Final Rule also states that issuers may accept payment after Dec. 31, 2013, for retroactive coverage effective January 1, 2014. HHS also requested that insurers allow customers additional time to pay the first month’s premium on marketplace plans.

The Rule also discusses continuity of care. The Rule strongly encourages, but does not require, insurers to smooth the transition to marketplace coverage by temporarily treating out-of-network providers as in-network, particularly if the insurer’s online provider directory is not completely current. It also suggests that to avoid care disruption, insurers consider a provider in-network if the provider was treating an acute condition at the start of the year. (Many states already have similar continuity of care requirements.)

Read Interim Final Rule here.

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