CMS Approves Special Enrollment Period for Individuals
The Centers for Medicare and Medicaid Services (CMS) has recently granted Land of Lincoln Health (LLH) individual policyholders a Special Enrollment Period (SEP) due to a loss of Minimum Essential Coverage (MEC).*
There will be two SEP deadlines available to individual LLH insureds on- and off-exchange.
August 2, 2016 – September 30, 2016: Individual policyholders can enroll in a new plan during this time period for coverage to take effect on October 1, 2016. Enrollment during this time period will ensure there is no gap in coverage.
October 1, 2016 – November 29, 2016: Individual policyholders can enroll in a new plan during this time period and coverage will take effect on the first day of the following month (either November 1st or December 1st depending on when an application is submitted). Enrollment during this time period will result in a gap in coverage for most policyholders.
Illinois Health Agents is here to help you transition your individual Land of Lincoln plans so you do not experience a gap in coverage and do not lose the financial assistance you may be eligible for.
Contact us now: August 2nd is less than two weeks away!
Contact an experienced agency today to walk you through your options at 312-588-9915 or email our support team at [email protected].
See our FAQ on LLH’s marketplace exit below to learn more.
*Note: An involuntary loss of coverage is a required SEP both on- and off-Exchange. If you are ineligible for financial assistance / subsidy, off-exchange paper application submissions remain as an option.
Land of Lincoln Health Exits Marketplace – FAQ
1. When will coverage with Land of Lincoln Health terminate?
Land of Lincoln Health issued a notice to members which indicates coverage for individual
policyholders will end on October 1, 2016. The notice does not specifically state if this will
also be the termination date for group health plans, but it indicates employer clients
should work with their producer to find a new plan.
2. When can a person with an individual health plan through Land of Lincoln Health change coverage?
There will be two special enrollment periods available to individual policyholders:
August 2, 2016 – September 30, 2016: Individuals policyholders can enroll in a new plan during this time period for coverage to take effect on October 1, 2016. Enrollment during
this time period will ensure there is no gap in coverage.
October 1, 2016 – November 29, 2016: Individual policyholders can enroll in a new plan during this time period and coverage will take effect on the first day of the following
month (either November 1st or December 1st depending on when an application is submitted). Enrollment during this time period will result in a gap in coverage for most policyholders.
3. When can an employer with a group health plan through Land of Lincoln Health change
Employers can immediately shop for a group health plan with another insurance carrier, but they will be subject to satisfying minimum participation and minimum contribution
requirements of the specific insurance carrier in which they elect to enroll.
4. What happens to the deductible and out-of-pocket expenses that Land of Lincoln Health
members have already satisfied?
For group health plans, some insurance carriers will apply a credit for deductible and/or
out-of-pocket expenses that have already been met for the year. Check with one of our
group sales representatives for more specific details.
For individual health plans, there will be no credit for any deductible or out-of-pocket
expense that has been met.
5. Is more information on the closure of Land of Lincoln Health available?
The notice to members issued by Land of Lincoln Health is the best resource available
today. It provides additional information on premium payments, claims and other
frequently asked questions. If more information becomes available, we will also make
that information available to you.
FOR INDIVIDUAL POLICYHOLDERS
6. What happens if I don’t enroll?
Your coverage with Land of Lincoln, assuming you have continued to pay your premium, will
terminate effective October 1, 2016. If you do not enroll during the Advanced Availability period of August 2, 2016 through September 30, 2016, starting October 1, 2016 you will have no health insurance coverage (unless you have chosen to purchase private health insurance coverage).
If you did not enroll during the Advanced Availability period, you may still enroll on the Federal Health Insurance Marketplace during the Normal SEP period of September 1, 2016 through November 29, 2016 for coverage effective the first of the following month (which will result in your having a period of time during which you have no health insurance coverage).
If you fail to enroll (or obtain private health insurance coverage) during either of the two enrollment periods, then you will not be able to enroll through the Federal Health Insurance Marketplace for health insurance coverage with an effective date prior to January 1, 2017, and will have no health insurance coverage from October 1, 2016 through the end of the year, December 31, 2016.
7. Will I be notified when the Special Enrollment Period Begins?
Land of Lincoln’s individual insureds will have an “Advanced Availability” enrollment period from August 2, 2016 through September 30, 2016 for coverage commencing on October 1, 2016; the benefit of enrolling during the Advanced Availability period is that you will have no gap in health insurance coverage.
Land of Lincoln’s individual insureds may also enroll during the “NORMAL SEP” enrollment period of October 1, 2016 through November 29, 2016, but coverage will not begin until the first of the following month, thereby resulting in a gap in health insurance coverage.
This information will also be available on the DOI web site http://insurance.illinois.gov/
7. Will I have to change doctors?
To compare plans and confirm what doctors/hospitals are in network for that plan, go to our quoting pageand access the tools to confirm if your preferred doctors and/or hospitals are available.
8. If I enroll in a new plan, will the amount of my monthly premium increase?
The amount of your monthly premium will change depending on the insurer and plan options that you may
choose. To compare plan options during the Special Enrollment Period, go to Healthcare.gov and access the
link to preview plans and compare prices.
9. If I enroll in a new plan, will I be credited with the deductible and out of pocket expense payments I have made?
Your obligation to pay deductibles and out of pocket expenses will be “reset” when you enroll in a new plan. The deductible and out of pocket expense payments you have made under your plan with Land of Lincoln will
not carry over to the new plan you select. You will have to meet the new deductible and out-of-pocket expense
requirements of the replacement plan you select.
10. Will my tax credit for having health insurance coverage with Land of Lincoln stay in place for the remainder of 2016?
If you are receiving a tax credit for your 2016 Land of Lincoln individual plan coverage and you enroll in a new 2016 marketplace plan during the SEP, you may continue to receive a tax credit based on your income.
11. Do I need to keep paying premiums to Land of Lincoln?
Yes, if you want to keep your Land of Lincoln coverage in force, you must continue to pay your premiums to Land of Lincoln. Please note: if your Land of Lincoln policy is cancelled for nonpayment of premium you will not be eligible for a special enrollment period.
12. Will my claims still be paid?
Yes, Land of Lincoln will continue to the pay claims of its current members.
10. Can I still see my doctors and other providers? What about ongoing or upcoming care? What about my prescriptions?
Yes, members can continue to see providers and receive coverage for both medical and pharmacy needs. If you have problems with providers not honoring your insurance, contact the Office of Consumer Health Insurance at
1(877)527-9431, or submit a written complaint at https://mc.insurance.illinois.gov/messagecenter.nsf.
11. What is the Illinois Life and Health Insurance Guaranty Association?
The Illinois Life and Health Guaranty Association (“ILHIGA”) (1520 Kensington Road, Suite 112 Oak Brook, IL 60523 (773) 714-8050 http://www.ilhiga.org) was created under Illinois Law in 1986. The purpose of ILHIGA is to provide protection for certain “covered persons” under life and health insurance policies issued by insolvent member companies. Insurance companies must hold a certificate of authority to transact life and/or health insurance business in Illinois to be an ILHIGA member company. In the event that an insurer becomes insolvent and is ordered into liquidation, ILHIGA provides coverage in accordance with 215 ILCS 5/ Article XXXIII ½. These statutory provisions set forth the ILHIGA’s contractual obligations and establish several important limits on coverage.