Guidance on Annual Eligibility Redetermination and Re-enrollment for Exchange Coverage for 2018
Guidance describing alternative procedures Exchanges using the federal eligibility and enrollment platform must follow for annual redetermination and automatic re-enrollment for benefit year 2018; affects Federally-facilitated, State Partnership, and State-based Exchanges using the federal platform, issuers, and enrollees receiving APTC or income-based CSRs.
Alternative procedures for 2018 largely retain 2017 procedures but add expanded IRS-based discontinuation rules for APTC/CSRs related to failure to reconcile.
Conditions for Discontinuing APTC and CSRs (2018)
Conditions for Discontinuing APTC and CSRs (2018)
Under the Exchange's alternative procedures for benefit year 2018, the Exchange will discontinue advance payments of the premium tax credit (APTC) and income-based cost-sharing reductions (CSRs) for certain enrollees. The Exchange will apply both retained procedures from 2017 and newly applicable procedures for 2018 as described below.
ALL of the following
- Were automatically re-enrolled by the Exchange for benefit year 2017 with APTC or income-based CSR.
- Were also automatically re-enrolled by the Exchange for benefit year 2016 with APTC or income-based CSR.
- Did not submit an updated application that was used as the basis for enrollment in a QHP for benefit year 2016 or 2017.
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