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Originally published Monday, August 25, 2014 at 8:50 PM

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Health-exchange problems prompt special enrollment period

Consumers who have problems with the handling of health-insurance plans they purchased through Washington Healthplanfinder may be eligible for a special enrollment in which they can choose another plan outside the exchange.


Special to The Seattle Times

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Responding to ongoing problems at the Washington Healthplanfinder insurance exchange, state Insurance Commissioner Mike Kreidler on Monday instituted a limited special enrollment period for consumers who want to obtain coverage outside the exchange.

From Aug. 27 to Nov. 14, those who have had problems with enrolling or making payments through Healthplanfinder can enroll in coverage outside the exchange either by selecting a different plan with the same carrier or by changing carriers.

“This is a problem that has been around since the end of December,” Kreidler said in an interview. “I am cautiously optimistic that the exchange is doing a much better job right now to resolve the problems, but there is no guarantee that they’re going to be gone as we go into open enrollment.”

Open enrollment for plans taking effect in 2015 begins Nov. 15.

It’s not clear how many people are eligible for the special enrollment. The Office of the Insurance Commissioner (OIC) did not specify whether eligibility covers both those who have current account problems and those who had problems in the past.

According to the Washington Health Benefit Exchange, which manages Healthplanfinder, a manual audit of accounts has cleared up virtually all the known problems. “We currently don’t have a large number of accounts still awaiting their payments to be distributed to the carriers,” said exchange spokeswoman Bethany Frey.

Even if they are eligible for the special enrollment, the OIC pointed out, some consumers may find that choosing a plan outside the exchange may not be the best option. That’s because those who leave the exchange cannot receive tax credits that help lower the cost of premiums. About 85 percent of those enrolled through the exchange receive tax credits, the OIC said.

Still, Kreidler said, even some consumers eligible for tax credits will appreciate the option to move outside the exchange. “We have had people contact us who are receiving subsidies saying, ‘Please, I don’t even want the subsidy. I just want to have an option. I don’t want to spend the money for subsidized premium and get nothing for it,’ ” he said.

Those who choose to take advantage of the special enrollment period are required to select a plan from the same “metal level” — bronze, silver or gold — that they chose in the exchange. The metal levels differ in the coverage offered, deductibles and other criteria. Kreidler recommended that consumers who want to retain premium subsidies, but who are having payment problems should make the payments directly to insurance carriers without leaving the exchange. On Aug. 7, the OIC announced that consumers who choose to exercise this option must first call the Healthplanfinder customer-support center at 1-855-923-4633.

The exchange, in a statement Monday, called the limited enrollment period “a short-term solution.”

The statement warned that consumers who choose to move outside the exchange could lose credit for payments made toward deductibles or out-of-pocket maximums for their current policies. And it said any claims that a consumer has incurred may not be covered if the consumer terminates coverage through Washington Healthplanfinder.

The exchange said it is moving to resolve the software problems that have caused the problems. “We are on-schedule to complete high priority system updates by Aug. 30, with additional updates coming in the month of September,” it said.

Patrick Marshall is a freelance writer in Seattle. This story was produced through a partnership with Kaiser Health News, an editorially independent part of the Kaiser Family Foundation.



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