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Special Enrollment Periods: What you need to know

Special Enrollment Periods

You may still be able to enroll in health insurance or change plans for the rest of 2019 if you qualify for a Special Enrollment Period. Here are 3 things you need to know about Special Enrollment Periods:

Special Enrollment Periods: What Is It?

An employee’s health insurance plan changes are subject to the ACA’s time constraints. When an employee needs to adjust their insurance outside of the yearly Open Enrollment period, they may do so during a special enrollment period (when all employees are normally able to update their insurance plans).

Only some life events trigger special enrollment periods. These are characterized as a shift in personal circumstances that necessitates an immediate adjustment to one’s medical coverage. Two examples are having a baby or a child leaving home and obtaining their own insurance.

Special enrollment periods under employer-sponsored health plans typically allow employees at least 30 days after a qualifying life event, during which they can re-enroll in the plan. Depending on the company, there may be certain exceptions. Qualified individuals are eligible for a 60-day extended registration period in the Federal Marketplace on HealthCare.gov.

Studying the Summary Plan Descriptions (SPDs) and other plan documentation from your insurance provider will help you learn about the special enrollment periods for your company’s plans and the types of life changes that qualify you for enrollment.

Why are special enrollment periods so essential?

During open enrollment, your employees can often only make changes to their health insurance plans once each year. This can be a hardship when life circumstances modify the necessity for specialized insurance coverage for employees and/or dependents.

Importance for Workers

Special enrollment periods allow employees to make necessary changes in response to qualifying life events. They may terminate coverage for themselves dependents or get coverage for new dependents.

Vitality for Employers

Special enrollment periods allow you to assist your employees with insurance changes without violating IRS and/or ACA requirements that govern your health insurance.

3 tips on getting health coverage outside Open Enrollment

  • Certain life changes make you eligible for a Special Enrollment Period. If you experience life events, like losing health coverage, getting married, or having a baby, you may qualify to enroll or change plans for the rest of 2019. Check out the full list of events, or answer a few quick questions to see if you’re eligible.
  • If you qualify, you have a limited window to act. You usually have up to 60 days after the life event to enroll in a plan. If you don’t act in time, you’ll have to wait until the next Open Enrollment Period to apply for 2020 coverage (unless you qualify for another Special Enrollment Period).
  • When you apply for Marketplace coverage through a Special Enrollment Period, you may be asked to provide documents to confirm the events that make you eligible. You must upload them before you can start using your coverage. You have 30 days to submit.

Learn more about getting coverage outside Open Enrollment.

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