What Is Special Enrollment?
Special enrollment is a period outside of Open Enrollment during which individuals with specific qualifying conditions are eligible to purchase health insurance through Covered California. If your clients happen to live out of state, they are eligible to use the Health Insurance Marketplace (or their state's equivalent) to purchase health insurance during special enrollment. Since it occurs outside of Open Enrollment, a special enrollment period can arise at any time from February 1 until October 31.
If you have clients who do not qualify for special enrollment (see below), they are still eligible to purchase health insurance during Open Enrollment. If they already have a plan, they can also alter it during Open Enrollment, which lasts from November 1, 2016 through January 31, 2017.
*For those individuals who receive Medi-Cal (or Medicaid for out-of-state residents) or children who qualify for the Children's Health Insurance Program (CHIP), there are no limited enrollment periods.
Who Is Eligible for Special Enrollment?
In order to be eligible for special enrollment, individuals must have experienced a qualifying life event. In most cases, individuals must enroll in a new insurance plan or alter an existing one within 60 days of the qualifying life event.
According to Covered California, if your client has experienced any of the following events, they are likely eligible to purchase insurance during a special enrollment period.
- Lost or will soon lose health insurance, which applies to those who have lost the following forms of coverage:
- Employer-sponsored coverage
- COBRA (however, failing to pay is not considered a loss of coverage)
- Student health coverage
- Eligibility under a parent's plan
- Eligibility for a child-only plan (cutoff age is 19)
- Permanently moved to or within California
- Moved to California from out of state
- Moved within California and gained access to at least one new Covered California health insurance plan
- Had or adopted a child; if fostering, you qualify but must indicate "adopted a child."
- In this instance, the entire family can enroll in coverage during the special enrollment period.
- If you place your child up for adoption or foster care, you can enroll during a special enrollment period.
- Were Married
- One or both partners are eligible to purchase coverage within 60 days of signing the marriage certificate.
- Returned from military service — active duty, reserve duty, or the California National Guard.
- Have been released from incarceration
- Became a citizen, national, or permanent legal resident
- Are a federally recognized American Indian or Alaskan Native
- As a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.
Other qualifying life events do exist (such as a terminal illness or becoming pregnant), so be sure to conduct exhaustive research on behalf of your clients to ensure that there are no missed opportunities. The Covered California website is a great resource for further information, and we will continue to focus on topics related to special enrollment periods, Open Enrollment, and the Affordable Care Act as a whole, so be sure to check back to learn more!
Learn More About the Canopy Health Network
If you or your clients are interested in learning more about the Canopy Health network, please give us a call at 888-8CANOPY. Our expansive network reaches across five counties (Marin, Alameda, Contra Costa, Sonoma, and San Francisco) and includes more than 4,000 physicians working at 12 hospitals and numerous outpatient facilities.
We are dedicated to quality care that is refreshingly clear and transparent, as well as the health and wellness of the entire Bay Area. Contact us today to learn more!
Qualifying life events for special enrollment. (2016). Covered California. Retrieved from http://www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/qualifying-life-events/