To better serve our members, customers and channel partners, we regularly review our internal policies. Beginning January 1, 2023, we aligned our policy for Off-Exchange plans with the Affordable Care Act’s (ACA) policy for switching roles. Per the ACA rules, when a subscriber terminates their coverage because they’re moving to group coverage or Medicare, their dependents qualify for a special enrollment period due to the loss of minimum essential coverage. Since switching subscribers on an existing account is considered a change to the contract structure, it requires the creation of a new account. This can only happen during open enrollment, or a special enrollment period and dependents will need to submit a new application. Previously, we processed this change using the Account Change Form.
When a dependent loses their coverage due to the subscriber moving to group coverage or Medicare, they have 2 ways to complete an application for health coverage:
When applying, the dependent will select “loss of minimal essential health coverage.” Existing Kaiser Permanente for Individuals and Families (KPIF) members don’t need proof of a qualifying life event if their qualifying event date matches what we have on record in our systems for their KPIF termination date. Be sure to include the dependent’s KP medical record number on the application. New applicants will need to provide proof of loss of coverage. Visit kp.org/specialenrollment for a list of acceptable documents.
If an existing KPIF plan subscriber wants to retain coverage for only their child or children (18 and younger), the subscriber can use the Account Change Form to terminate coverage for themself and their spouse, if applicable, and leave the child or children on the account. The subscriber remains on the child-only account as a non-covered subscriber. In section B of the Account Change Form, the subscriber will need to select one of the following:
If you have clients that are in transition and the subscriber/spouse are terminating their KPIF coverage, that’s a good time to re-evaluate the family’s needs and see if they may now qualify for financial assistance. Visit buykp.org or log into your SMU account to run a quote and ensure your clients are getting the best coverage for their needs and wallet.
If you have any questions about this process change, please contact the KPIF Broker Support team by emailing kpif@kp.org or by calling 844-394-3978, option 1, Monday through Friday, 11:30 a.m. to 8 p.m. ET.
