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Alliant Health Plans would like to share an important update regarding our process for sending termination letters to members, which may result in increased member inquiries to you.
Context:
The Center for Medicaid and Medicare Services (CMS) required termination letters to be sent to members whose policies have been technically terminated, regardless of the reason or scenario. To comply with CMS regulations, our Eligibility and Billing Department began sending termination letters to affected members beginning In May 2024 with termination notices dating back to January 2024.
Why Members are Receiving Termination Letters:
The regulation mandates that we must send termination letters if a member’s policy is terminated for any reason. However, there are several scenarios where a member might still have coverage even though they receive a termination letter. This can understandably cause confusion. Below are some common scenarios:
1. Policy Termination and New Policy Activation
a. A member terminates their current policy and activates a new one. Despite the new coverage, they receive a termination letter for the old policy.
2. Technical Errors and Reinstatements
a. A policy is terminated due to a technical error on HealthCare.gov, but the member subsequently wins an appeal or resolution, reinstating their coverage. Despite the reinstatement, they still receive a termination letter for the initially terminated policy.
Example Scenarios Causing Confusion
1. Scenario 1:
a. Member Situation: John Doe terminates Policy A effective June 30, 2024, and activates Policy B starting July 1, 2024.
b. What happens: John receives a termination letter for Policy A, which may cause confusion since he is covered under Policy B.
2. Scenario 2:
a. Member Situation: Jane Smith’s policy is terminated due to a technical error. She appeals and wins, reinstating her original policy.
b. What happens: Jane receives a termination letter for the policy that was technically terminated due to the error, even though her original policy coverage has been reinstated.
Action Required:
Please review the attached sample templates of the termination letters we are sending to members. We encourage you to familiarize yourself with these templates and the scenarios outlined above so you can better assist your clients who may reach out with questions.
We understand this new process may increase member inquiries and we appreciate your cooperation in helping to clarify the situation for our members.
Termination Letter Sample Templates:
OFF Exchange Non-Effectuation Letter
ON Exchange Non-Effectuation Letter
OFF Exchange Voluntary Termination Letter
ON Exchange Voluntary Termination Letter
If you have any questions or need further clarification, please reach out to your Account Executive.
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