Enrolling into health insurance schemes can seem like a complicated enough process at the best of times. Each scheme has its benefits and circumstances and its open enrollment system.
Some, such as Medicaid and CHIP have open enrollment all year round, but others do not. The good news for many citizens is that there are special enrollment periods for health insurance for those that qualify.
What Is A Special Enrollment Period?
These periods offer an opportunity for people to qualify for insurance outside of the normal enrollment periods. They are available to those that apply for help under particular life circumstances.
As things stand, there are variations under different schemes, and the rules apply to conditions in 2016. It is currently unclear what the future holds for these schemes under future legislation from the Trump administration.
What Do Companies Mean By The Term “Qualifying Life Event”?
Most healthcare providers will use the term “qualifying life event” when talking about the circumstances for special enrollment.
A qualifying life event is a hardship or sudden change in circumstances that affects the applicant’s claims and needs. This is usually a change in family status, the loss of a current plan or another significant event. There is also the possibility to apply after a missed deadline.
Most providers allow for a 60 day period after the event where applicants can apply for a new plan. Some go as far as 120 for some life events.
There is no guarantee that an applicant will be able to apply after missing a deadline. However, there are circumstances where providers may make exceptions. This includes those that made an account but were unable to complete the application due to a technical error.
Error messages and unresolved case work could be grounds for the application. It is also important to remember that applicants may have a claim if there was misconduct on an original request. Those that can prove they received the wrong plan due to misconduct may have an opportunity to reapply.
Loss Of A Plan:
Those that lose their current health insurance plan may be able to apply for another outside of the open enrollment system. This means that a sudden loss of health coverage, for whatever reason, don’t have to be the end of the world.
The window here is open from 60 days before the planned ending and 60 days afterward. This could mean no loss of coverage and a smooth transition where possible. There is also the chance to apply through a special window if Medicaid or CHIP denied coverage. Here there are 60 days from the denial.
Significant Life Event That Changed Circumstances:
This tends to be births, marriages, and deaths where the set up of the household has changed significantly. Again, this tends to be a 60 day period after the event. Be aware that adoption comes into play here as well as birth.
A change of residence or financial circumstances could also act as a qualifier. This could be as simple as a change in address or as complicated is gaining citizenship.
As for the financial implications, a change in salary or a loss of tax credits could be enough. Also, there is the opportunity for victims of domestic abuse to claim separately from their spouse in special enrollment periods.
Significant Life Event That Prevented Enrollment:
It is also important for applicants to remember that they may be eligible if they were unable to apply due to life events. These events are usually restricted to hospitalization, cognitive disability, and natural disaster.
Applying For A Special Enrollment Period Or An Appeal
Any applicant that has failed to enroll in Medicaid or CHIP, or meets the qualifications, needs to contact a representative.
There are many opportunities for special enrollment for health insurance that can help people in need. In fact, there are probably more opportunities that than many suspects.
Anyone denied Medicaid or CHIP, or that goes through a life changing circumstance, should consider applying to alter the plan. Even those that denied insurance have the chance to appeal. Those that fail at the appeal stage will need to consider private insurance.
The world of special enrollment for health insurance may seem complicated, but there are options and advisers. All applicants should consider their possibilities for the best healthcare provision.