Qualifying Life Events for ACA Special Enrollment Periods
As of 2014, there is a big change in individual health insurance. Employees can only enroll in guaranteed-issue individual health insurance during specific open enrollment periods and special enrollment periods. Employees are eligible for a special enrollment period if they have a qualifying event.
The new enrollment periods apply to qualified health plans bought through both the state health insurance exchanges and outside the exchanges through a broker or health insurance website.
This article outlines the qualifying life events (aka "triggering events") that make an employee eligible to enroll in individual health insurance coverage outside of the open enrollment periods - called a special enrollment period. After a qualifying event, enrollees generally have 60 days to enroll in a plan.
What is a Qualifying Life Event?
A qualifying event is a life event which makes you eligible for a special enrollment period. If you have a qualifying event you can enroll in individual health insurance outside of the annual open enrollment period. This is called a special enrollment period. The special enrollment period generally lasts 60 days after the qualifying event.
Here are a few examples of qualifying life events:
- Loss of Essential Health Coverage: You lose, or one of your dependents loses health coverage that meets minimum government standards.
- Change Your Family Size: You get married or divorced, have a death in the family, or have a child by birth or adoption.
- Change Citizenship Status: You become a U.S. citizen, national, or gain lawful status in the U.S.
- Experience Government Error: You lose, change, or enroll in coverage because of an error committed by an officer, employee or agent of the Exchange or the Department of Health and Human Services as determined by the Exchange.
- Change Premium Tax Credit Eligibility: You are determined newly eligible or newly ineligible for federal assistance (advance payments of the premium tax credit, cost sharing reductions, or Medicaid). See eligibility for premium tax credits here.
- Move to a New Coverage Area: You permanently move to a new area (ex: state or county) and gain access to new qualified health plans.
What are the Enrollment Period Dates?
Here's a summary of the enrollment period dates and deadlines.
|Initial Open Enrollment (for coverage in 2014)||October 1, 2013 to March 31, 2014|
|Annual Open Enrollment (for coverage in 2015)||November 15, 2014 to February 15, 2015|
|Special Enrollment Period (after a qualifying event)||Generally 60 days from qualifying life event|
What if You Miss an Enrollment Period?
If you miss the open enrollment period, and do not have a qualifying life event that makes you eligible for a special enrollment period, then you will have to wait until the open enrollment period starts again in the fall to purchase or change your health plan.