Understanding Special Enrollment Periods and Qualifying Life Change Events

As a result of the Affordable Care Act, people who want to sign up for private insurance have to do so during the nation-wide open enrollment period. The next open enrollment period will be from November 1, 2015, though January 31, 2016. Until then, people will only be able to shop for new coverage or make changes to their existing coverage if they meet certain criteria cialis forum doctissimo to qualify for a special enrollment period.

What is a Special Enrollment Period?

A special enrollment period is the period of time when consumers have the opportunity to shop for a new private health insurance plan or change their existing private health insurance plan. The special enrollment period is a 60-day window that begins on the date of a qualifying life change event.

What is a Qualifying Life Change Event?

A qualifying life change event may allow an individual or family to make changes to their current coverage or sign up for new coverage. Some qualifying life change events only apply to people who have an existing health insurance plan. Although most qualifying life change events apply whether or not the customer is shopping through a health insurance marketplace, the chart below is specific to qualifying life change events that prompt special enrollment periods to shop through Colorado’s health insurance marketplace, Connect for Health Colorado.

Qualifying Life Change Events for Colorado’s Health Insurance Marketplace

New Customers

Allowed to shop for a new health insurance plan
  • Family grows through birth or adoption
  • New legal partnership (e.g. marriage, civil union)
  • Health insurance through a different source is no longer available (e.g. coverage through a family member, employer-sponsored coverage, Medicaid, or CHP+)
  • Employer-sponsored coverage becomes unaffordable
  • Gain of citizenship or legal immigration status in the U.S.
  • Permanent move to Colorado
  • American Indian/Alaska Native status changes
  • Misconduct of an enrollment assistor (not associated with the marketplace)
  • Leaving incarceration (e.g. consumer is released from prison or jail)
  • *Note: Colorado’s Division of Insurance decided that a special enrollment period will not be available to individuals in 2015 who will have to pay a tax penalty for not having health insurance in 2014.

Current Customers

Allowed to shop for a new plan or make changes to an existing health insurance plan
  • Family grows through birth or adoption
  • New legal partnership (e.g. marriage, civil union)
  • Health insurance through a different source is no longer available (e.g. coverage through a family member, employer-sponsored coverage, Medicaid, or CHP+)
  • Employer-sponsored coverage becomes unaffordable
  • Gain of citizenship or legal immigration status in the U.S.
  • Permanent move to Colorado
  • American Indian/Alaska Native status changes
  • Misconduct of an enrollment assistor (not associated with the marketplace)
  • Customer is newly eligible or ineligible for Advanced Premium Tax Credits
  • Change in eligibility for Cost Sharing Reductions (CSRs), or change in level of CSRs
  • Incorrect/inappropriate enrollment in a health plan that is not due to the consumer’s error
  • Health insurance carrier has violated contract
  • New location of legal residence with access to new Qualified Health Plans through the marketplace

Current Customers

Allowed to make changes to an existing health insurance plan
  • Household size is smaller (e.g. divorce, death)
  • A dependent is turning 26 and is no longer eligible for coverage under the parent’s plan
  • Household member has a change in tobacco use status
  • Household member gains other minimum essential coverage

 

When to Report a Life Change Event

If a consumer has coverage through Connect for Health Colorado, or plans to shop for coverage through Connect for Health Colorado, life change events need to be reported to the Connect for Health Colorado Customer Service Center (855-752-6749) within 60 days of the event. In some cases, the customer will also have to report the change to the health insurance carrier.

A person has a total of 60 days to report and enroll in new coverage or make a change to existing coverage after the date of the qualifying life change event. If a person is losing coverage due to job loss, the 60 days starts on the date the consumer will lose health coverage, which may or may not coincide with the date that employment ends. Remember that for people enrolled in Medicaid or Child Health Plan Plus (CHP+), changes to household size and income should be reported within 10 days to the human services office in the client’s county of residence or through PEAK.

Getting Coverage for the Following Month

The effective date of new coverage in most cases will be the first day of the following month, after the plan is purchased or after updates are submitted. In cases of birth or adoption, coverage should begin on the date of birth or adoption. Call the Connect for Health Colorado Customer Service Center (855-752-6749) to ensure the coverage will start on the correct date.

Types of Coverage Not Subject to Special Enrollment Periods
  • Medicaid and CHP+ have year-round enrollment, and eligible people can enroll at any time during the year. Learn more about eligibility and how to apply here.
  • Vision and dental coverage do not have special enrollment periods. Customers can enroll at any time during the year.
  • Members of federally recognized Indian tribes and Alaska Native shareholders can sign up for or change plans once per month throughout the year.
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Stephanie Brooks is the Policy Analyst for Colorado Covering Kids and Families (CKF). CKF's mission is to increase access to affordable health coverage and high quality health care by ensuring that Medicaid, Child Health Plan Plus, and subsidized private insurance through Colorado’s state-based marketplace consistently meet the needs of low-income Coloradans. The Colorado Community Health Network is the lead agency for the project.