II. Grab Bag FAQ: Potential impact of a life change on health plans’ deductibles
Q1: If someone reports a life change to the Marketplace but stays with the same issuer, does the issuer have the option to reset the deductible and/or accumulators?
A1: It depends what effect the life change has on the enrollment group. If the change results in the subscriber remaining as part of the enrollment group and the group remains in the same plan, CMS requires issuers to continue accumulators such as amounts paid towards deductibles and out-of-pocket maximum amounts. However, if the subscr
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Q1: If someone reports a life change to the Marketplace but stays with the same issuer, does the issuer have the option to reset the deductible and/or accumulators?
A1: It depends what effect the life change has on the enrollment group. If the change results in the subscriber remaining as part of the enrollment group and the group remains in the same plan, CMS requires issuers to continue accumulators such as amounts paid towards deductibles and out-of-pocket maximum amounts. However, if the subscr
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