Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 07, 2014

Program Area: Enrollment and Eligibility (ENR)

Question: If an enrollee returns to the Federally-facilitated Marketplace (FFM) (for example, by accessing HealthCare.gov) updates his or her application, and selects a new medical QHP will s/he be able to keep his or her current SADP through the auto-enrollment process?

Answer: During the Annual Open Enrollment period for the 2015 benefit year, if an enrollee returns to the FFM (for example, by accessing HealthCare.gov) updates his or her application and selects a new medical Qualified Health Plan (QHP), the enrollee will need to re-select his or her Stand-alone Dental Plan QHP (SADP) at the same time, since the FFM requires that, if a consumer wants to select an SADP, the SADPs be selected simultaneously with a QHP. If upon returning to the FFM an enrollee wants to select the same SADP under which s/he is currently covered, s/he may use the SADP plan ID to search for his or her plan to ensure that s/he is selecting the same coverage. If an enrollee does not actively select a QHP or (QHP and SADP) by midnight on December 15, 2014, the Marketplace will process an auto-enrollment and enroll the person for 2015 coverage in a QHP and, if applicable, SADP per the hierarchy set forth at 45 CFR 155.335(j) and the business rules established for the 2015 Plan ID Crosswalk Template. In these instances, if the enrollee can be auto-enrolled into 2015 QHP coverage, s/he also will be auto-enrolled in SADP coverage, if SADP coverage remains available for 2015, in accordance with the hierarchy set forth at 45 CFR 155.335(j), as applied to SADPs, and the business rules established for the 2015 Plan ID Crosswalk Template.

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