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Affordable Care Act: Life After Open Enrollment

Have questions about what happens after March 31? We have answers!

Have questions about what happens after March 31? We have answers!

What you should know about the end of Open Enrollment and Special Enrollment periods.

March 31 is the last day anyone can sign up for an individual or family medical plan for 2014, whether it’s through a health insurance marketplace, a broker/agent, or directly with an insurance carrier.

Special Enrollment

Between April 1 and November 14, individuals and families can enroll for coverage, or change coverage, for 2014 only if they experience a situation known as a “triggering event.”

Examples of triggering events include: getting married, having a baby, or losing coverage due to the loss of a job. Triggering events vary by region and jurisdiction.

The triggering events defined by the Affordable Care Act (ACA) include events such as:

  • Loss of health care coverage
  • Loss of job
  • Having a baby
  • Getting married
  • Changes in income that result in an individual either qualifying, or not qualifying, for federal tax credits
  • Permanent relocation that results in the loss of your former health care
  • Changes in immigration status
  • Determination by a health insurance marketplace that you are entitled to a special enrollment period
Note: This is not the complete, official list, and the states and the District of Columbia have added additional triggering events to the federal list.

A special enrollment period lasts 60 days after the triggering event occurs, meaning that individuals who experience a triggering event have 60 days from that date to change, or apply, for health care coverage for themselves or any dependents.

The next open enrollment period is scheduled to run from November 15, 2014, through February 15, 2015. During that period, anyone can apply for 2015 coverage without experiencing a triggering event.

Note: Individuals who lose their group coverage during the 2014 portion of open enrollment for 2015 plans can use a special enrollment period to enroll in seamless coverage for 2014; they won’t have to wait until January 1, 2015, to start coverage.

Triggering Event Confirmation Requirements

When a triggering event occurs, confirmation requirements will vary depending on whether the person applies directly through a carrier or through a marketplace.

Individuals who experience a triggering event will typically need to send a letter to their carrier confirming the triggering event along with an application for coverage and their first month’s premium. However, certain carriers such as Kaiser Permanente, will require that they receive the letter within 10 calendar days of the application’s submission or the end of the special enrollment period, whichever comes first. This letter must be sent with the first month’s premium and will need to include:

  • individual’s name & address as seen on the application
  • explanation of what their triggering event is
  • date of the triggering event

Failure to send the triggering event letter within the carrier’s specified window of time could result in the cancellation of their application.

Individuals who experience a triggering event and qualify for federal assistance are required to enroll through the health insurance marketplace.

Feel free to contact us to learn more about the Special Enrollment period!

Partner Agency Insurance Services, Inc. can provide you with professional expertise in understanding your health care options, guidance in application and eligibility process. In addition, we can offer you affordable health care coverage through Covered California or directly with medical insurance carriers for Individuals and Families or Employer Group coverage for groups of any size. Please feel free to contact us for a complimentary quote from a variety of carriers at (714) 482-9500.
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