Many Californians still do not understand why they cannot enroll all the time for health insurance. In order to avoid that people enroll only when they need medical assistance, the Affordable Care Act implemented specific Enrollment Periods. In the Open Enrollment which starts from November 1st to December 15th, and in California until January 31st of a year, anyone can enroll in a health plan without underwriting of their health status. In the Special Enrollment Period, which is between February 1st to October 31st, one can apply for health insurance if they have a qualifying life event, whereby the life event has to be proven with certain documentation.
Below is a list of some of the most common qualifying life events to enroll in a plan during the Special Enrollment Period.
- Recently married/divorced
- Loss of Medi-Cal (increased income over Medi-Cal income threshold)
- Loss of health insurance coverage due to employment change
- Newborn child (effective date will be newborn’s birth date)
- Change of income (for those already enrolled in a Covered CA plan)
- Moved from out of state or from a different region in CA
- Turned 26 years old (lost parent’s coverage)
The period outside of the Open Enrollment Period is described as the Special Enrollment Period. You must have a qualifying life event to enroll in a health insurance plan during this time. Furthermore, you must enroll in a health insurance plan within 60 days of your qualifying event and provide proof of your qualifying event. This is in contrast to the Open Enrollment Period at which time no qualifying life event underwriting takes place.
The effective date of your health insurance plan depends on your application date and qualifying life event. For most qualifying life events, you must apply by the 15th of the month to get a plan effective the following month. If you apply after the 15th, your plan will be effective the month after next.
On the other hand, the effective date is subject to each insurance carrier and depends on the qualifying life event. For example, most carriers assume a newborn child’s effective date as the date of birth. For a loss of coverage due to unemployment, many carriers will allow you to enroll in a health insurance plan for the following month even if you enroll after the 15th of the month.
We can review your qualifying life event and help you find a plan on or off the exchange during the Special Enrollment Period.
For those that do not have a valid qualifying life event, there are several options to consider. Short-term medical insurance is an option and covers you in the case of an accident or illness. These types of plans are not Affordable Care Act compliant and do not cover pre-existing conditions or limited preventative care. For global citizens, they have the option to enroll in global health insurance which can cover more medical services than a short-term medical plan but may also be subject to exclusions such as pre-existing conditions, pregnancy, etc.
Please contact us at Solid Health Insurance Services and we can help you figure out if your qualifying event is valid, what your effective date is, and what documents are required to provide to each insurer to prove your qualifying life event. We are more than happy to guide foreign or dual citizens with their insurance options as well. Contact us by email at firstname.lastname@example.org or call us at (310)-909-6135 or visit our website at www.solidhealthinsurance.com