Marketplace Policies May Require Additional Information
The Health Insurance Marketplace recently sent notices requesting validation of information provided during the Marketplace enrollment process to certain policyholders. If you have received one of these notices we encourage you to immediately contact the Marketplace if you have not already done so.
There are about 30 different reasons why a Marketplace customer may need to provide additional information. The Marketplace may refer to these reasons for additional information as “inconsistencies.” We have not been informed by the Marketplace as to which reason applies to any given policyholder.
Since the Marketplace mails the notice to customers directly, we do not know ahead of time which customers will be contacted by the Marketplace. However, now that customers have received the Marketplace notice, carriers may also be sending reminder notices to affected customers based on the mailing list provided by the Marketplace.
If you receive such a notice, it is critical that you respond to the Marketplace directly with the additional information within the timeframe outlined in the letter.
Do not send any information regarding noted inconsistencies to carriers. Customers must sign in to access HealthCare.gov or call the Marketplace and provide the required information directly. We cannot facilitate responses to the Marketplace on behalf of our Marketplace policyholders.
What happens if policyholders don’t respond?
Failure to provide the Marketplace with the requested information may result in the cancellation of current coverage, changes to plan coverage, changes or loss in current tax credits and/or impacts to cost-sharing reductions.
Failure to verify citizenship or immigration status with the Marketplace within the timeframe they provide will result in the loss of eligibility for coverage. Depending on residency status, policyholders may have the option to continue their coverage off the Marketplace. However, they won’t be eligible to receive a tax credit or cost-sharing reductions.
Failure to verify income information may result in reconsideration of a policyholder’s eligibility and/or recalculation of the amount of tax credit or cost-sharing reductions they are eligible for. This means policyholders may lose some or all of their premium credit, and their premium responsibility could increase. As a result, policyholders may owe additional money to the federal government when filing their taxes.
Note: Termination of coverage due to failure to pay premium is not a Qualifying Life Event (QLE) and would not constitute special enrollment eligibility outside Annual Open Enrollment.
If any of these events occur, policyholders may be eligible for coverage during a Special Exception Period (SEP) off the Marketplace.
Who should you contact with additional questions?
For more information about Marketplace validation requests, to get online document upload instructions and/or to request paper copies of any required documents, existing policyholders should:
- Visit your Marketplace account at HealthCare.gov or
- Call 800.318.2596 (TTY: 855.889.4325)
