Updated Qualifying Event Rules- Kaiser

Effective July 11, Qualifying Event2016, Kaiser Permanente is requiring an updated qualifying event (triggering event) form, in order to qualify California applications from Kaiser individuals and families outside of the normal open enrollment season.

Examples of triggering event documentation include

Kaiser’s New Rules For A Qualifying Event – What it’s about

The purpose of Kaiser Permanente’s new form is to clarify what qualifies as a Permanent Relocation.  Kaiser Permanente applications received outside of the normal open enrollment period must include the new form and documentation of qualifying health coverage from the prior insurance carrier in the last 60 days, plus one of the following:

  1. Utility Bill
  2. Copy of Rent Agreement

View the new rates: Get your personalized quote directly from Kaiser

Kaiser Permanente Individual and family plans website

A Closer Look at Permanent Relocation as a Qualifying Event

The Department of Health & Human Services, skilled at making simple programs far more difficult, issued some “help” in January 2016, as exemplified below:

If an individual moves to a new Exchange service area (i.e. state) and meets the requirements in 45 C.F.R. § 155.305(a)(3)—as explained in Questions 1 and 4 above—with respect to the new location, then the individual will meet the Marketplace residency requirement in the new location.

Did you enjoy that?  The document goes so far as to define the meaning of “intends to reside.” [ref: Q3. What does “intends to reside” mean?]

If you enjoy plowing through such rhetoric, read the full document here.  However, you would be much better served reading Michelle Andrews’ excellent contribution to Kaiser Health News, written last January.

If not, here’s another helping hand from our friends at the DEPARTMENT OF HEALTH & HUMAN SERVICES’ Centers for Medicare & Medicaid Services’ Center for Consumer Information and Insurance Oversight:

Q12. How does someone qualify for the Permanent Move S E P to enroll in a QHP or change their enrollment in a QHP?

To qualify for the Permanent Move S E P under 45 C.F.R. § 155.420(d)(7), a QI or his or her dependent must gain access to new QHPs as a result of a permanent move. 4 For the purposes of qualifying for this S E P, a move is considered permanent if a QI (or his or her dependents) moves and meets the Marketplace residency requirement—as described in Questions 1 and 4 with respect to a new location. An individual who moves to a new location temporarily without an intent to reside there or otherwise meeting the Marketplace residency requirement, including for personal pleasure or to obtain medical care, does not qualify for the Permanent Move S E P. Similarly, an individual who moves permanently, but does not gain access to new QHPs as a result of the move, would not qualify for the Permanent Move S E P. For example, this may occur if an individual permanently moves within the same apartment building, neighborhood, town, or county, depending on the QHPs offered in the individual’s service area.