Changes to take effect for Special Enrollment Periods (SEPs)
Wellmark is changing the paperwork required for Special Enrollment Periods (SEP) in the
Individual Under 65 market. Individuals who enroll during SEPs will need to provide proof of eligibility to ensure they are qualified for coverage. The documentation requirement change takes place for SEPs with a signature date of
4/1/16 or later for an effective date of
5/1/16 or later. This change is being made not only for new SEP contracts, but also SEP contract changes. In order to ensure adherence to the documentation requirements, Wellmark will also be instituting an audit process of individuals enrolled through a SEP. We will be sending out an Agent Alert communication that outlines this audit process in more detail.
If a member enrolls during a SEP they don't qualify for, and then cancels that coverage soon after receiving their insurance benefits, it has an adverse effect on the entire Wellmark insured population. By requiring proof of SEP eligibility, we better protect our current members from unnecessary risk and the increased costs it can generate.
Attached is a summary of the SEPs and the paperwork required to meet proof of eligibility as mentioned above. Producers will need to gather the required SEP documentation for individuals, submit it to Wellmark, and maintain the documentation in their files/records. These SEP documents will then be subject to Wellmark audits to maintain accuracy.
Across the industry, the individual market continues to be financially challenging. We know you support our goals to encourage a stable market and to keep coverage affordable for our members. By working together, we can manage the risks that our members are exposed to. Thank you in advance for your support of these updates that can help us accomplish our mutual goals.
Please note that if Partners Health Insurance helps you enroll applications or change forms, the applications cannot be submitted until we also have the additional documentation on file.
For additional questions, please contact your Individual Account Rep:
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