New process for special enrollment in individual off-exchange plans
September 22, 2015
Paper applications now required for SEP off-exchange enrollments
Starting September 25:
- Anthem Blue Cross will accept only paper applications for special enrollment in individual plans sold off the exchange. Online applications for plans sold off the exchange during a special enrollment period (SEP) are no longer accepted.
- We will require proof of the qualifying event (QE) with the paper application.
- This change does not impact enrollment in plans sold on the exchange.
Agent quote online, submit on paper
You [Agents] will still be able to generate an off-exchange proposal online. But you’ll no longer be able to complete an online application for off-exchange special enrollment. When you send your clients a quote, they will still be able to navigate to the beginning of the online application. From there, they’ll get instructions on how to access a PDF of their application, pre-filled with your agent details. They can print and complete this application by hand, then mail it in. Or if you’re completing the application with your client, you can print the application and submit it via E-Submit. Remember to write your client’s name on the top of each page of supporting documentation.
Why this change?
This change in process will help us better comply with the requirement to show documented proof of a qualifying event included with the application. As you know, SEP is that time when your clients need to have a life-changing event (QE) — such as marriage, divorce, a new baby, or loss of other coverage — to be eligible to enroll in a health care plan outside the open enrollment period.
- As noted above, documentation of the qualifying event must be submitted with the paper application.
- Applicants cannot submit their application or proof of their qualifying event online.
Online application is for open enrollment only
Starting November 1, you’ll be able to use the online application for 2016 open enrollment. But regardless of when a qualifying event happens, SEP applications will be accepted only on paper for individual plans sold off the exchange.
Online applications started before September 25
- Consumers can get to their In Progress applications from their dashboards
- Producers can access their clients In Progress applications from the In Progress Applications tab. The Edit and Transfer buttons will take the producer to the Application Overview page
- What about agent attestation? For SEP applications submitted before September 25th, producers can complete the agent attestations on Producer Toolbox. For SEP applications submitted after September 25th, Producers will need to complete the agent attestation portion (Section I) on the paper application.
- Neither consumers nor producers can re-enter the online application screens. This means they won’t be able to continue or submit.
- Consumers and producers have the option to print the PDF application and complete it by hand. This will contain any information already completed (including producer data). It also gives instructions to mail the application with documented proof of the qualifying event.
Applies to: California individual and family plans (under 65)
