April 28, 2017

 The U.S. Department of Health and Human Services (“HHS”) has issued a final rule which, among other things, changes the annual Health Insurance Marketplace open enrollment period for the 2018 plan year and modifies the rules for Marketplace special enrollment periods.


The final rule changes the dates for open enrollment in the individual Marketplace to November 1, 2017 through December 15, 2017. Accordingly, this change will require individuals to enroll in coverage prior to the beginning of the year, unless they are eligible for a special enrollment period.


The final rule also makes the following modifications to Marketplace special enrollment period rules:

  •          Starting in June 2017, HHS will conduct pre-enrollment verification of eligibility for Marketplace coverage for all categories of special enrollment periods for all new consumers in all states served by the platform.

  •          The ability of existing Marketplace enrollees to change plan metal levels during the coverage year will be limited.

  •          Issuers will be permitted to deny Marketplace special enrollment due to loss of minimum essential coverage where the issuer has a record of termination due to non-payment of premiums by the individual, unless obligations for premiums due for previous coverage are fulfilled.

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