Enrollment and Eligibility (ENR) FAQ
Guidance for FAQ regarding Reconciliation and Discrepancies
Program Area: Enrollment and Eligibility (ENR)
Question: Some enrollments that use the term "ward" to designate disabled dependent status, may not actually be disabled dependents. If an issuer is concerned that an enrollment is not accurate, how should the transaction be handled? How will issuers reconcile information with the Federally-facilitated Marketplace?
Answer: Generally, if a qualified individual has designated a dependent as a ward, the issuer may assume the individual is eligible to enroll, and that s/he is a disabled dependent. However, issuer specific verification activities following enrollment are permissible. More information on processing inconsistencies in enrollment transactions will be forthcoming.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 19, 2013
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