(This information concerns Individual & Family Health Plans. It does not concern you if you are either on a Medicare Health Plan or on an Employer-Sponsored Group Health Plan)
The year-end Open Enrollment Period for Individual Health Plans ended on January 31, 2016. However, certain individuals may still be able to apply for a health plan in 2016. This special circumstance is called the Special Enrollment Period (SEP). You need to have a Qualifying Event (QE) to qualify. Here’s what you need to know.
You can buy health coverage outside of the open enrollment period when you have a qualifying life event—through a special enrollment period (SEP). Most SEPs last 60 days from the date of the qualifying life event.
Qualifying life events for a SEP include:
- Getting married or entering a domestic partnership
- Child aging off a plan
- Gaining a dependent or becoming a dependent through marriage, birth, adoption, or placement for adoption or foster care
- Permanently moving to a new area that has different health plan options
- Employer coverage not being considered minimum essential coverage
- Losing other healthcare coverage that is considered minimum essential coverage, such as due to job loss, termination of employer health plan by the employer or expiration of COBRA coverage
- Returning from active military service
- Change in eligibility for advance premium tax credit or cost-sharing subsidies
Please note that voluntarily terminating other health coverage or being terminated for not paying premiums is not considered a qualifying event.
All insurance companies will require written proof that you have an acceptable qualifying event. When enrolling during an SEP, please make sure to include qualifying events verification documents in the application.
This is a link to Blue Shield of California’s interpretation of the ACA laws regarding SEP and QE’s. Different carriers may have slightly different interpretations and requirements.
https://bliscorp.egnyte.com/dl/QJhtXag1KT
Phil Lee
Lee Health Insurance Services (BLIS Corporation)
925-284-2000
www.linkedin.com/in/philwlee www.yelp.com/biz/lee-insurance-services-lafayette-7Affordable
About Phil Lee