Conditions and issuer actions applicable to affected individuals and QHP issuers:
Individuals who experienced an SEP-qualifying event between 60 days prior to the FEMA incident period start date and December 31, 2017, and who attest they resided in counties declared by FEMA for individual or public assistance are eligible for an additional 60-day Exceptional Circumstances SEP to complete 2017 enrollment.
Affected individuals may select a new 2017 QHP or change their existing 2017 QHP through the FFE at any time through December 31, 2017, and may request a retroactive effective date no earlier than the date that would have applied if they had selected a plan on the FEMA-designated incident start date in their service area.
The FFE will waive pre-enrollment verification requirements and permit attestation for applicants with pended enrollments created between 60 days prior to the FEMA incident start date and December 31, 2017, who attest to residing in areas affected by hurricanes.
Individuals attesting to residence in affected areas are eligible for an Exceptional Circumstances SEP extending the 2018 Annual Open Enrollment Period through December 31, 2017; such individuals may request enrollment after December 15, 2017.
Enrollees may terminate coverage through the FFE for any reason; enrollees who terminate due to hurricane-related hardship may be exempted from associated tax penalties per CMS exemption guidance.
Issuers, in response to state requests or direction, may set more generous binder payment deadlines to effectuate prospective coverage, including allowing binder payments more than 30 days after the coverage effective date or effectuating prospective coverage after receipt of the enrollment or the applicable effective date under 45 CFR 155.400(e).
CMS will allow issuers to comply with state authorities' requests to provide enrollment extensions for enrollments occurring up to one week before the FEMA incident period start through the end of the incident period; absent specific state guidance, issuers may allow up to 60 days from the original binder payment deadline.
Where an affected individual's three-month APTC grace period expires on or after one week prior to the FEMA incident period start date, CMS will not take enforcement action against an issuer that does not immediately terminate coverage at the end of the three-month grace period; the issuer may grant an additional 60 days or a state-determined extension to satisfy past due premiums.
For APTC recipients benefiting from any grace period extension, issuers must pay all appropriate claims for services rendered during the first month of the grace period, may pend claims for subsequent months, notify HHS of non-payment of premiums, notify providers of possible denied claims beyond the first month, and return APTC for subsequent months if the enrollee exhausts the grace period.
Issuers must provide adequate notice to enrollees that coverage will not be terminated in accordance with 156.270(g) and explain how grace period extensions affect Guaranteed Availability, particularly where delinquent payments may be required before issuing or renewing coverage under the Market Stabilization Rule.
CMS may consider refraining from compliance actions where a QHP issuer's noncompliance was directly caused by storm conditions and could not have been reasonably prevented.