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Frequently Asked Questions
Is an issuer permitted to decline placing individual coverage based on a consumer's ownership of an existing major medical policy?
45 CFR 147.104 of the new guaranteed issue regulation does not allow you to base a member's eligibility upon not having another major medical policy. The only limitations on guaranteed issue are listed in 45 CFR 147.104. The regulation does not address coordination of benefits. The preamble to the final regulation points out that "Section 2724(a)(1) of the Public Health Services Act (PHS Act) provides that nothing in part A or part C of Title XXVII of the PHS Act should be construed to preempt any state law that does not prevent the application of a federal requirement." So Michigan's Coordination of Benefits Act and the coordination of benefits language in each contract would determine which coverage is primary.
Can issuers offer certain plans off the marketplace that are not offered on the marketplace, and vice versa?
Plans may be offered only off the Marketplace, but if a plan is offered on the Marketplace it must also be available off the Marketplace.