The Washington Health Benefit Exchange (WAHBE) recently further extended an emergency special enrollment period (SEP) for the uninsured.
The SEP, which was set to end on May 15, has been extended to August 15. This gives consumers additional time to take advantage of new savings through the American Rescue Plan Act (ARPA). It gives new and current enrollees an additional 3 months to enroll or reevaluate their coverage needs with increased tax credits available to reduce premiums.
WAHBE is targeting May 8 to conduct the redetermination of subsidy calculations. Carriers will begin to receive this information soon after.
Kaiser Permanente members and mutual clients enrolled in an individual plan through WAHBE should expect to hear from WAHBE soon about any changes to their subsidy.
Most members won’t need to take any action; however, they should keep their income and contact information up to date to receive the latest information. Some members will be notified on what actions to take.
If you have clients who aren’t enrolled in an individual plan through WAHBE, they may now be eligible for premium assistance or a tax credit if their premiums for the WAHBE benchmark plan would exceed 8.5% of their income. They may want take advantage of this opportunity for 2021.
The SEP parallels the federal COVID-19 SEP extension on HealthCare.gov by the Centers for Medicare & Medicaid Services.
Who is eligible for the SEP?
- Uninsured individuals and families signing up for new coverage are eligible for the SEP. Enrollees do not need to have experienced a qualifying life event or other special circumstance and do not need qualifying proof.
- Those currently uninsured, seeking coverage, or enrolled in a health-sharing ministries, short-term limited duration plan, or COBRA can enroll.
- Members and mutual clients who are currently enrolled through WAHBE, and have tax credits that are changing, or who are over 400% of the Federal Poverty Level (FPL) and become newly eligible for tax credits can enroll.
Limitations to the SEP
New enrollees can choose any carrier and plan. Current members are allowed to make a metal level plan change with their current carrier.*
Timeline and premium payment requirements
Enrollments that occur on or before the 15th of the month will have a coverage start date of the first day of the following month. Enrollments after the 15th will have a coverage start date that begins the first of the second month.
Coverage purchased through the WAHBE requires that the initial payment be made 30 days from the effective date of coverage before being canceled for nonpayment.
Off-exchange enrollees will receive a billing statement for their premium, and they should pay their premium by the first of the month coverage is effective.
Who can assist prospective members?
Clients seeking coverage through Washington Healthplanfinder need to work through an exchange-certified producer or one of the resources provided on the Washington Healthplanfinder website.
For clients seeking individual coverage off the exchange, we encourage you to send them your link to the Kaiser Permanente Washington off-exchange enrollment portal. If you need more information about this option, contact the Individual & Family producer support team at 1-800-474-1079 or ifsales@kp.org.
*Current members over 400% of the FPL who become newly eligible for tax credits under ARPA have existing SEP rights to change carriers.
