After big insurers like UnitedHealthcare threatened to leave the Obamacare exchanges because of abuse of the system, the Centers for Medicare and Medicaid Services (CMS) announced this past week that it was creating a Special Enrollment Period (SEP) Confirmation Process, to be phased in after public feedback.

The CMS site says:

Once the new Special Enrollment Confirmation Process is implemented, all consumers enrolling through the most common SEPs will need to submit documentation to verify their eligibility to use an SEP. The Special Enrollment Confirmation Process will be accompanied by other improvements to the SEP application process….

Over the next few weeks, CMS will invite comment from consumer advocates, insurance companies and other stakeholders on the key features of the new Special Enrollment Confirmation Process, such as communication with consumers, acceptable documentation, and refining and targeting the verification process. These comments will help inform implementation of the new process.  This announcement builds on action CMS has taken to eliminate unnecessary SEPs and clarify the rules for other SEPs.

The Confirmation Process will require written substantiation by the applications to prove they qualify for an SEP. Other verification steps may also be required.

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