2015 Individual Under-65 Off-Marketplace Rules Iowa Specific At Group Benefits, Ltd. (GBL), we pride ourselves on doing the right thing and going above and beyond for our agents. That s why rather than providing our agents carrier guides for the Special Enrollment Period (SEP), our team of individual health experts created this easy-to-understand comparison guide to help you make the right decisions for your individual under-65 clients. GBL s SEP Tip Sheet has been reviewed by Wellmark Blue Cross and Blue Shield of Iowa and Coventry Health Care of Iowa. The information provided here is how GBL and the listed carriers interpret their guidelines as of February 16, 2015. This is not intended to be a comprehensive list of all qualifying events and is subject to change at any time without notice. We will update this tip sheet as carrier information changes and the most up-to-date version will be housed on the GBL Agent Portal for download. Developed by Group Benefits, Ltd. All Rights Reserved. Last Updated March 13, 2015 Carrier Disclaimers Wellmark Blue Cross and Blue Shield of Iowa This list is not intended to be a comprehensive list of all qualifying events and is subject to change at any time without notice. Wellmark Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross Blue Shield Association. Coventry Health Care of Iowa This list is not intended to a comprehensive list of all qualifying events and is subject to change. The effective date will not be assigned prior to the qualifying event. It will always be assigned on or after the qualifying event, based on when the application was submitted.
from event date. New baby, mother, and spouse. ACA Plans - The date of birth. GF/NGF Plans - The date of birth. New baby, mother, spouse, and dependents. The date of birth. Online or paper application. Copy of birth certificate required. Paper change form. Copy of birth certificate required. prior to Individual, spouse, and newly gained dependents. ACA Plans - Date of adoption, placement for adoption or placement in foster care. GF/NGF Plans - The date of adoption, placement for adoption, or placement in foster care. with adoption or placement documentation. with adoption or placement documentation. New dependent as a result of adoption or placement for adoption. Date of birth, adoption or placement for adoption. Online or paper application. Copy of adoption paperwork required. Paper application. Copy of adoption paperwork required. prior to If the individual voluntarily terminates coverage without losing their job, this does not constitute an event. If the individual voluntarily terminates coverage without losing their job, this does not constitute an event. 1st day of month following application received by Coventry. Online or paper application. Termination letter from employer, pay stubs current & previous if hours have been reduced, or letter from employer stating no longer paying for insurance required. Paper application. Termination letter from employer, pay stubs current & previous if hours have been reduced, or letter from employer stating no longer paying for insurance required. prior to Individual who lost coverage due to turning 26. ACA Plans - 1st of the month following dependent turning 26. GF/NGF Plans - 1st of the month following policy anniversary date. GF/NGF-Change Form (N-5428 12/14) to choose the exact same plan and maintain their GF/NGF status. Individual turning 26. 1st day of the month following app receipt by Coventry. Online or paper application. Copy of carrier letter documenting loss of coverage due to loss of dependent status required. Paper application. Copy of carrier letter documenting loss of coverage due to loss of dependent status required. 1.
Wellmark must receive application/change form no more than 60 days prior to Spouse and dependents being removed due to divorce. GF/NGF- Change Form (N-5428 12/14) to select exact same plan Person who has to leave the existing coverage. Online or paper application. Copy of divorce decree or custody agreement required. Paper application. Copy of divorce decree or custody agreement required. Wellmark must receive application/change form no more than 60 days prior to Online or paper application. Termination letter of loss of Medicaid or CHIP coverage from the insurance carrier including the date of the loss of coverage required. Paper application. Termination letter of loss of Medicaid or CHIP coverage from the insurance carrier including the date of the loss of coverage required. prior to Individual, spouse, and newly gained dependents. and, for domestic partners, a partnership certification is required. and, for domestic partners, a partnership certification is required.. Individual, spouse, and dependents. Online or paper application. Copy of marriage license or domestic partner certificate required. Paper application. Copy of marriage license or domestic partner certificate required. prior to 1st of the month following the event. ACA Plans- Change Form (N-5432 11/14) GF/NGF Plans- Change Form (N-5428 12/14) 1st-15th of month: Online or paper application. Documentation showing that you are no longer eligible for a health insurance exchange subsidy is required. Paper application. Documentation showing that you are no longer eligible for a heath insurance exchange subsidy is required. 2.
prior to Individuals listed on the current pre-aca plan. 1st of the month following the event. and letter communicating renewal/ termination and crosswalk. ACA Plans- Change Form (N-5432 11/14) and letter communicating renewal/termination and crosswalk. GF/NGF Plans- Change Form (N-5428 12/14) and letter communicating renewal/termination and crosswalk. Online or paper application. Copy of carrier letter communicating that current pre-aca coverage will end on a certain date is required. AWAITING CARRIER CLARIFICATION prior to Online or paper application. Copy of letter documenting loss of minimum essential coverage required. Paper application. Copy of letter documenting loss of minimum essential coverage required. prior to Individual(s) who permanently move to Iowa. and proof of old residency and new residency (e.g. old driver s license, or mail with former address and mail with new address). and proof of old residency and new residency (e.g. old driver s license or mail with former address and mail with new address). and proof of old residency and new residency (e.g. old driver s license, or mail with former address and mail with new address). Online or paper application. Proof of move such as utility bill or rental/ lease agreement from both the prior residency and new residency required. Paper application. Proof of move such as utility bill or rental/lease agreement from both the prior residency and new residency required. prior to ACA Plans - 1st of the month following the event. GF/NGF Plans - 1st of month following the event. Online or paper application. Documentation showing date that COBRA coverage ends and the people covered by COBRA required. Paper application. Documentation showing date that COBRA coverage ends and the people covered by COBRA required. 3.
prior to event date and within 120 days from event date. Individual returning from military service and his/her spouse and dependents. ACA Plans - NGF/GF Plans - The reinstatement date will be: - The date of discharge or inactive status from military service - Termination of military health coverage, or - The first of the following month and discharge papers. ACA Plans -Change Form (N-5432 11/14) and discharge papers. 1st-15th of month: Online or paper application. Supporting paper-work confirming departure date from active military service required (discharge papers). Paper application. Supporting paperwork confirming departure date from active military service required (discharge papers). prior to 1st-15th of month: Online or paper application. Copy of certified letter documenting release date from incarceration required. Paper application. Copy of certified letter documenting release date from incarceration required. prior to Children named in court order. ACA Plans - The date of the required court order coverage. GF/NGF Plans - The date of the required court order coverage. and court order. and court order. and court order. Individual(s) on the court order. 1st-15th of month: Online or paper application. Copy of legal supporting documentation requiring healthcoverage required. Paper application. Copy of legal supporting documentation requiring health coverage required. 4.