In MassHealth, eligibility and coverage are concurrent, but that is not true in the Health Connector. Once found eligible for ConnectorCare, an applicant must take further action to affirmatively enroll by certain deadlines before coverage can begin. Enrollment can only occur during an annual open enrollment period or after a qualifying event that occurs outside open enrollment and creates a special enrollment period as discussed in the next three Q & As.
In general, enrollment is prospective after selecting a plan and paying any premium due. At initial enrollment, plan selection and payment of the first month’s premium must be completed by the end of the day on the 23rd of the month in order for coverage to begin on the 1st of the following month. The applicant can also select a date on the first of a later month within the enrollment period, however, an individual who misses the deadline for the initial month he or she selected will have to “shop” again and affirmatively select coverage for a later month within the enrollment period.
There are limited opportunities for retroactive enrollment in ConnectorCare. Retroactive enrollment will always require a special request to Customer Service or an appeal. After certain kinds of special enrollment periods including those based on errors, or misrepresentation by the Health Connector or its agents, contract violations, “special circumstances” identified by the Connector or in some failure to verify situations, the effective date of coverage may be an “appropriate date based on the circumstances of the special enrollment period.” 45 CFR 155.420(b)(2)(iii). As discussed below in a later Q & A, a hearing officer can also set a retroactive effective date after a successful appeal.
- In training for enrollment assisters in the summer of 2018, the Connector described a policy for retroactive enrollment based on an error by the Health Connector, a member’s hospitalization, a death in the family or other exceptional circumstances that prevented an individual from selecting a plan and paying the premium. The process requires the applicant to request retroactive enrollment from a Health Connector Customer Service representative and pay all monthly premiums for the requested months as well as the next month’s premium. The process may take 10-15 business days to complete and some requests may require health plan approval.
45 CFR 155.420(b)(Effective dates). Health Connector Policy, NG-3, Enrollment in Individual and Family Plans, Jan. 1, 2015.