1332 Waiver Guidance

[Penelope]

​

1332 Waiver Guidance

October 25 2018 (most missed it due to the bomb scare)

While waivers must still provide coverage that is comprehensive and affordable, the Guidance allows waivers to allow states to provide coverage that is less affordable and less comprehensive. Meaning, a waiver may still be approved if it provides less access to comprehensive or affordable coverage, relative to the ACA, so long as the waiver continues to provide some access to comprehensive and affordable coverage. In doing so, the Guidance expressly encourages states to seek waivers to expand access to AHP and STLDI. While less costly, AHPs and STLDIs can exclude individuals with pre-existing conditions and exclude coverage for certain health benefits such as mental health, prescription drugs and/or maternity care. A state proposing a waiver for AHPs and STLDIs could now be approved so long as state residents still have access to other comprehensive and affordable coverage.

Snip

In summary, with this Guidance, HHS and Treasury show a readiness to approve proposals that were previously denied under the protections contained in the Obama Administration’s guidance. In the coming months, we expect to see states that had previously had Section 1332 Waivers rejected, seek to submit new waiver applications to have those previously rejected coverage and affordability proposals approved under this new Guidance.

Six Things to Know About the New Section 1332 Waiver Guidance - Lexology

-----------------------------------------------------
Also allowing companies not to cost share insurance. Better investigate, I know all the GOP are pushing PEC's but you are going to pay big time if you are allowed ins at all. They are lying as they all voted to repeal the ACA in whole.

If you decide on a skimpy plan (cheap), watch out if you get HTN, DM, any and all conditions, soon females will pay more as well.

Yes Trump lies and lies , but we are too busy with the bomb scare, to note other minor changes. .

 

[sparky]

 

[Penelope]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

 

[Penelope]

This is the AHP.
The rule would empower small businesses and self-employed individuals to band together to purchase coverage through "association health plans" or AHPs. They are exempt from many of Obamacare's mandates, which have been responsible for premiums soaring. As a result, these plans could provide small businesses who previously didn't offer health insurance an affordable means of doing so.
------------------------------------------------
I thought that was what the ACA was for, the gig society, WARNING: watch out for illnesses or health conditions.

 

[sparky]

This is the AHP.
The rule would empower small businesses and self-employed individuals to band together to purchase coverage through "association health plans" or AHPs. They are exempt from many of Obamacare's mandates, which have been responsible for premiums soaring. As a result, these plans could provide small businesses who previously didn't offer health insurance an affordable means of doing so.
------------------------------------------------
I thought that was what the ACA was for, the gig society, WARNING: watch out for illnesses or health conditions.

yeah well, one needs to consider the devil in the details Pene, for starters the SBA defines sm biz as under 500 ,which is ridiculous considering most of this country's true <small> biz's are 5 employees and under

so you see, the larger majority of such entities aren't liable to provide their employees anything, and usually don't

The fact is the many nay sayers of our illustious at the time governance (Truman? Eisenhower?) were drowned out when they decided to thrust HC onto the backs of employers.

Now thaty's the biggest liability, try getting a job w/HC perks after 50/55.....ain't happening for most of us

Want that 25% unemployment (speculative reality V what we're told) to go away ,and make us more competitive w/globalization?

Take it off our backs

thx

~S~

 

[debbiedowner]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

 

[debbiedowner]

This is the AHP.
The rule would empower small businesses and self-employed individuals to band together to purchase coverage through "association health plans" or AHPs. They are exempt from many of Obamacare's mandates, which have been responsible for premiums soaring. As a result, these plans could provide small businesses who previously didn't offer health insurance an affordable means of doing so.
------------------------------------------------
I thought that was what the ACA was for, the gig society, WARNING: watch out for illnesses or health conditions.

This so far is not going very well.

 

[Penelope]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

 

[debbiedowner]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

Most people won't take cobra for a short period between jobs or being covered otherwise. No agent in the right mind would sell an ACA plan for 60 days they wouldn't waste their time, some don't even get a commission in certain states with different companies so therefore they got out in the past couple of years, other's usually don't make anymore than $100 per sale now and if paid and if the person only keeps it 60 days or even less than a year all or part of that money the agent was paid is taken back. We don't work for free.

 

[Penelope]

This is the AHP.
The rule would empower small businesses and self-employed individuals to band together to purchase coverage through "association health plans" or AHPs. They are exempt from many of Obamacare's mandates, which have been responsible for premiums soaring. As a result, these plans could provide small businesses who previously didn't offer health insurance an affordable means of doing so.
------------------------------------------------
I thought that was what the ACA was for, the gig society, WARNING: watch out for illnesses or health conditions.

yeah well, one needs to consider the devil in the details Pene, for starters the SBA defines sm biz as under 500 ,which is ridiculous considering most of this country's true <small> biz's are 5 employees and under

so you see, the larger majority of such entities aren't liable to provide their employees anything, and usually don't

The fact is the many nay sayers of our illustious at the time governance (Truman? Eisenhower?) were drowned out when they decided to thrust HC onto the backs of employers.

Now thaty's the biggest liability, try getting a job w/HC perks after 50/55.....ain't happening for most of us

Want that 25% unemployment (speculative reality V what we're told) to go away ,and make us more competitive w/globalization?

Take it off our backs

thx

~S~

That is why large companies get rid of those over 50 and they sure do not hire them. We have the ACA for small businesses and independent contractors. Any employers that has 50 or more full time employees (29 hours or more) need to cost share health ins.

That is why they are creating the AHP's and there is no mandate anymore.

 

[Penelope]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

Most people won't take cobra for a short period between jobs or being covered otherwise. No agent in the right mind would sell an ACA plan for 60 days they wouldn't waste their time, some don't even get a commission in certain states with different companies so therefore they got out in the past couple of years, other's usually don't make anymore than $100 per sale now and if paid and if the person only keeps it 60 days or even less than a year all or part of that money the agent was paid is taken back. We don't work for free.

You can sign up yourself under special enrollment. If you are out money and ins, you can get on the expanded Medicaid if your state has it. We went on cobra in the early 90's. Then again we didn't have anything like the ACA or any other option. If you have a PEC you are probably out of a luck without cobra or the ACA, by the way it sounds.

 

[debbiedowner]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

Most people won't take cobra for a short period between jobs or being covered otherwise. No agent in the right mind would sell an ACA plan for 60 days they wouldn't waste their time, some don't even get a commission in certain states with different companies so therefore they got out in the past couple of years, other's usually don't make anymore than $100 per sale now and if paid and if the person only keeps it 60 days or even less than a year all or part of that money the agent was paid is taken back. We don't work for free.

You can sign up yourself under special enrollment. If you are out money and ins, you can get on the expanded Medicaid if your state has it. We went on cobra in the early 90's. Then again we didn't have anything like the ACA or any other option. If you have a PEC you are probably out of a luck without cobra or the ACA, by the way it sounds.

Sure you can go direct or call them and sign up for a SEP but in the past year that has become one big hassle and although they say your effective date will be the 1st of next month and it will be but only once you get proof to them you lost coverage, then you might have to prove income, then this and that gets lost at the marketplace and in month two you run to the er or doc and whoops you really have no coverage.

I have always been in the middle between the two sides on the ACA and as the years have gone by thinks it needs to be vastly overhauled or scrapped for something new. The idiots at the marketplace could care less if you get insurance and it's been that way since inception, you can't blame one party over another they just don't give a shit and in the past year they have fired a big portion of their employees and says to call an agent. Well they never wanted agents before and it's hard to believe.

Something no one has posted on here and I've been waiting for two weeks, so healthcare.gov was hacked and 75,000 individuals had personal info stolen. It has been shut off to all agents and they say we'll have access November 1. They have narrowed the attack down to a WBE and some agents national producer numbers either still alive or dead. A WBE is a redirect that an agent can sign into the company they represent and go direct through that portal to healthcare.gov to complete an application. There are a few national WBE's that represent many companies and I would suspect it is one of them. I don't know if this could do them any good because many insurance companies will remain paying the agent or agency of record (the first ones who wrote them) and they will get paid regardless of who re enrolls them. You can find the info if you google the hack and you should be able to find a page explaining from CMS.

 

[debbiedowner]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

--------------------------------------------------
Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

Most people won't take cobra for a short period between jobs or being covered otherwise. No agent in the right mind would sell an ACA plan for 60 days they wouldn't waste their time, some don't even get a commission in certain states with different companies so therefore they got out in the past couple of years, other's usually don't make anymore than $100 per sale now and if paid and if the person only keeps it 60 days or even less than a year all or part of that money the agent was paid is taken back. We don't work for free.

You can sign up yourself under special enrollment. If you are out money and ins, you can get on the expanded Medicaid if your state has it. We went on cobra in the early 90's. Then again we didn't have anything like the ACA or any other option. If you have a PEC you are probably out of a luck without cobra or the ACA, by the way it sounds.

Yep, on the PEC.

 

[debbiedowner]

Well here's an update I just received:

Agents/Brokers: Following last week’s breach in the Direct Enrollment (DE) pathway, CMS has implemented new security measures to protect consumer information.



As of October 26th, the DE Agent/Broker pathway is now available again. Prior to putting the system back online, CMS worked with our partners in the HHS OIG and the HHS CIO to improve the security of the system. With this action, all enrollment pathways are now operational, including the DE Classic (double redirect) pathway for agents and brokers to assist consumers, HealthCare.gov and the Marketplace Call Center.



We are continuing to assess the information that was accessed as a result of the breach, but can now confirm that no banking, federal tax information (FTI), or protected health information (PHI) was exposed. Once this assessment is completed, affected individuals will be notified as quickly as possible by phone and mail.



Affected individuals will be able to register for free credit protection and additional services to prevent and/or remediate issues arising from unauthorized use of data exposed as a result of the breach, including identity monitoring services, identity theft insurance, and identity restoration services.

 

[sparky]

That is why large companies get rid of those over 50 and they sure do not hire them

yeah....sure.... thx Pene....

 

[Penelope]

Well here's an update I just received:

Agents/Brokers: Following last week’s breach in the Direct Enrollment (DE) pathway, CMS has implemented new security measures to protect consumer information.



As of October 26th, the DE Agent/Broker pathway is now available again. Prior to putting the system back online, CMS worked with our partners in the HHS OIG and the HHS CIO to improve the security of the system. With this action, all enrollment pathways are now operational, including the DE Classic (double redirect) pathway for agents and brokers to assist consumers, HealthCare.gov and the Marketplace Call Center.



We are continuing to assess the information that was accessed as a result of the breach, but can now confirm that no banking, federal tax information (FTI), or protected health information (PHI) was exposed. Once this assessment is completed, affected individuals will be notified as quickly as possible by phone and mail.



Affected individuals will be able to register for free credit protection and additional services to prevent and/or remediate issues arising from unauthorized use of data exposed as a result of the breach, including identity monitoring services, identity theft insurance, and identity restoration services.

I am very pro the ACA and expanded Medicaid. The best thing that happened to ins forever. The time to get ins is when you are healthy, if you wait for a PEC you were SOL. The gov needed to work with the ACA and expanded Medicaid, not destroy it. Everything needs work, and updating.

Trump care is no care.

 

[debbiedowner]

Well here's an update I just received:

Agents/Brokers: Following last week’s breach in the Direct Enrollment (DE) pathway, CMS has implemented new security measures to protect consumer information.



As of October 26th, the DE Agent/Broker pathway is now available again. Prior to putting the system back online, CMS worked with our partners in the HHS OIG and the HHS CIO to improve the security of the system. With this action, all enrollment pathways are now operational, including the DE Classic (double redirect) pathway for agents and brokers to assist consumers, HealthCare.gov and the Marketplace Call Center.



We are continuing to assess the information that was accessed as a result of the breach, but can now confirm that no banking, federal tax information (FTI), or protected health information (PHI) was exposed. Once this assessment is completed, affected individuals will be notified as quickly as possible by phone and mail.



Affected individuals will be able to register for free credit protection and additional services to prevent and/or remediate issues arising from unauthorized use of data exposed as a result of the breach, including identity monitoring services, identity theft insurance, and identity restoration services.

I am very pro the ACA and expanded Medicaid. The best thing that happened to ins forever. The time to get ins is when you are healthy, if you wait for a PEC you were SOL. The gov needed to work with the ACA and expanded Medicaid, not destroy it. Everything needs work, and updating.

Trump care is no care.

But the republican's are saying they're going to protect pec until at least after the election.

 

[Doc1]

What are STLDI's???
Short-Term, Limited Duration Insurance Proposed Rule: Summary and Options for States

Table 1. Consumer Protections in ACA Plans Compared to Short-Term Coverage

Consumer Protection ACA Plans Short-Term Coverage
Includes coverage for preexisting conditions? No – short-term plans can decline to offer coverage at all or exclude coverage for preexisting conditions

Prohibits higher rates based on health status? No – short-term plans can charge a higher rate based on an individual’s health status

Covers essential health benefits? No – coverage varies by plan and many exclude benefits such as prescription drugs, maternity, mental health and substance use disorder services

Prohibits dollar caps on health care services? No – short-term plans can include a dollar cap on services and stop paying medical bills after that cap is reached

Caps out-of-pocket expenses for consumers? No – short-term plans may not have a maximum limit on consumer out-of-pocket costs

Allows consumers to use federal premium assistance based on their income? No – premium tax credits cannot be used to purchase short-term plans

Satisfies the individual mandate? No – consumers enrolled in a short-term plan may have to pay a penalty for failing to have minimum essential coverage


To address concerns that STLDI was being sold as a primary form of coverage, and that these plans were likely to lead to adverse selection against the risk pool for the ACA-compliant market, the tri-agencies promulgated regulations in 2016 that imposed additional limits on STLDI. These rules, applicable to policies sold after January 1, 2017, prohibited STLDI from providing coverage for a period of three months or more, including any renewal period.

The Trump administration’s proposed rule would reverse the 2016 rulemaking and allow STLDI to provide coverage for up to 12 months, returning the federal definition to the duration in effect prior to January 1, 2017. The proposed rule would also allow policies to be renewed upon reapplication by the policyholder and with the consent of the insurer.

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Now the ACA says yes to all the above. What the hell do you need insurance for if you are as pure as the driven snow in your health, are you a ghost without a body?

This is the new TrumpCare!!

The only reason to purchase a STM is to fill a gap between one coverage ending and another picking up in 30 or 60 days in case of an emergency, otherwise they are junk. Some insurance agents make real good money pushing these junk plans all year long and happy as hell with the new rules but it never really matter to them.

If you don't have a PEC , and isn't Cobra still in effect? That is what the ACA is for, a gig society and in between jobs.

Most people won't take cobra for a short period between jobs or being covered otherwise. No agent in the right mind would sell an ACA plan for 60 days they wouldn't waste their time, some don't even get a commission in certain states with different companies so therefore they got out in the past couple of years, other's usually don't make anymore than $100 per sale now and if paid and if the person only keeps it 60 days or even less than a year all or part of that money the agent was paid is taken back. We don't work for free.

You can sign up yourself under special enrollment. If you are out money and ins, you can get on the expanded Medicaid if your state has it. We went on cobra in the early 90's. Then again we didn't have anything like the ACA or any other option. If you have a PEC you are probably out of a luck without cobra or the ACA, by the way it sounds.

One must QUALIFY for an SEP.