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Rule extends health insurance marketplace application, payment deadlines

December 13, 2013

The Centers for Medicare & Medicaid Services yesterday issued an interim final rule formally extending to Dec. 23 the deadline for qualified applicants to select a health plan through the new health insurance marketplaces for coverage effective Jan. 1. The previous deadline was Dec. 15. The rule also requires insurers to accept the first premium payment through Dec. 31, and allows the marketplaces to accept premium payments after Jan. 1 for coverage retroactive to Jan. 1 if permitted by applicable state law. State-run marketplaces have the option to select a different date. In addition, CMS said it is encouraging insurers to treat out-of-network providers as in-network to ensure continuity of care for acute episodes or if the provider was listed in their plan’s provider directory as of the date of enrollment; and to refill prescriptions covered under previous plans during January. The rule, which also applies to the Small Business Health Options Program, will be published in the Dec. 17 Federal Register with comments accepted through Dec. 23.