19 February 2016
Category Health

2016 Qualifying Life Events and Special Enrollment Periods

2016 Open Enrollment Period ended on January 31, but many individuals will still need health coverage for the remainder of 2016. Some of these individuals are still able to enroll for coverage and make changes to their existing coverage however they first must meet certain criteria to be eligible.
• Are they eligible for a Special Enrollment Period (SEP)? – This is a period of time outside of open enrollment when an individual can sign up for health insurance through the Health Insurance Marketplace. The individual must have an eligible Qualifying Life Event. An individual may qualify for a SEP of 60 days following certain qualifying life events.
• What is a Qualifying Life Event (QLE)? – It is an event that has altered or changed the individual’s life. Some examples of the most common QLE’s are moving to a new state, certain changes in income, changes in family size (getting married, divorced or having a baby), and loss of current health insurance coverage.
• How can they enroll or make changes? -Enrollments for individuals that qualify for a SEP, currently enrolled through the Health Insurance Marketplace or new applicant can be completed through the Direct Enrollment Tool, where they are directed to the Marketplace. The process is essentially the same as during open enrollment, If it is for an Off Marketplace plan, the process is the same as during open enrollment except that an event date will be required when quoting.
• When does coverage start? –The coverage start date will depend on the QLE. Some coverage could be effective the day of the event while some are effective the 1st of the following month. Once eligibility is determined, the carrier will assign the correct effective date.
• What if they are not eligible? – If the individual is not eligible for a SEP, they will have to wait to enroll till the 2017 Open Enrollment Period.

Contact Elisa@icusa-tx.com for more information

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