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Your Guide: Private Health Insurance Exchanges

Today we’re going to look at “private health insurance exchanges.” This has been one of the biggest buzz phrases in the health insurance industry over the past couple of years for a number of different reasons. The biggest reason though, is healthcare reform. With the implementation of new provisions required in the Affordable Care Act, the way that employers offer health insurance to their employees is changing.

We’ll take a look at the workings and the structure of private insurance exchanges. We’ll also describe the different components that make-up a private health insurance exchange, the types of businesses that should be taking the closest look at these exchanges, how private exchanges work, and why they’re growing in importance.

Private health insurance exchanges are exactly what they say they are: they’re exchanges that are set up privately through an employer. Many private health insurance exchanges utilize two important components:

  1. Technology and software: software programs help facilitate administration of private health insurance exchanges. Technology keeps the private exchange concept simple for both the employer and the employee. One example is http://www.liazon.com. Liazon’s platform allows an employer to define a contribution (much like an allowance), and then employees select their own health benefits. Simply, it’s an employee’s money to spend how he/she wants. The software keeps track of funds spent, shows the employee what kind of health insurance options are available in the private exchange, and allows employees to select plans they want.
  2. Group health insurance plans: in the past, many employers only offered one group health insurance plan. Administration of multiple plans could be a challenge. So to fix that problem, software companies (like Liazon) have arrangements with insurance companies that allow the employer to more easily offer multiple group health insurance plans, from multiple carriers. The important word here is multiple. With the software and technology that’s available, it’s not nearly as difficult to offer a selection of group health insurance plans anymore. This is important because one of the biggest goals of private health insurance exchanges is to provide choice. By utilizing a private exchange, employees now have choice.

There are additional ways to set up private health insurance exchanges, but businesses with +50 full time equivalent employees will almost always be utilizing the two concepts we’ve described above. And that’s who this article is intended for: businesses that are mandated to provide coverage. However, smaller businesses can also utilize this exact same strategy. If you’re a business that is at 20 employees or above, you’ll want to understand this concept.

Question: Why are private health insurance exchange becoming more important?

Here’s why:

  • Private health insurance exchanges give employees choices. Instead of being “stuck” in one group health insurance plan, they can more efficiently choose which plans fit them best. Having choices is now more important than ever before, because dependents (spouses and children) need to have affordable access to coverage. In the past, sometimes it was flat-out too expensive for an employee to include their dependents. The private exchange concept helps alleviate that issue.
  • Businesses with +50 full time equivalent employees are mandated to provide coverage. A private exchange is a cost-effective and budgetable way for employers in the “large group” category to provide coverage. You decide on the amount (called a “defined contribution”), and then give that amount to each employee. They pick the plan they want.
  • Efficiency. If employees are making their own decisions and picking their own plans, the whole system becomes more efficient. Instead of you telling them what they get, they instead pick what they want. When consumers are making choices, they’re more conscience about where money is being spent.

That’s the basic break-down of private health insurance exchanges. Unlike public health insurance exchanges (ie: state & federal exchanges), private exchanges are completely administered within the private workplace.

As mentioned, private exchanges can be an exceptionally important concept for those businesses in the +50 employee range. They accomplish three very important things: budgetability, selection, and flexibility. Those qualities will be very significant to businesses that are mandated to provide coverage. However, this same concept can work very well for smaller businesses too (in the 20+ employee range).

We work with private health insurance exchanges at Policy Advantage Insurance Services. If you are an employer that fits into the “group-sizes” we’ve described, contact us anytime if you have questions.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

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Consumer Checklist: Helping Small Business Navigate Healthcare Reform

Today we’re going to provide small businesses with some information about healthcare reform. We’ve put together a checklist, so you can walk through each important item one-by-one.

What does a checklist do? It helps you navigate. If you have a checklist of items, you’ll know exactly what you need and where to get those items. It’s just like running errands. By having a checklist, you won’t forget the important things either. The things that will save you time, money, and help you improve coverage.

Item #1: Determine if you’re a small business.

This is number one. You want to establish this right away. Why? Because there are costly tax penalties that may be incurred if you’re actually a “large business” and don’t provide health coverage to your employees. As it stands, “large businesses” are mandated to provide healthcare coverage to their workers. Small businesses are not.

Knowing whether-or-not you’re a small business will also help you determine your plan design strategies. Providing health benefits for yourself or your employees as a small business owner differs greatly compared to those of large businesses.

Question: What is the definition of “small business” with regard to the healthcare reform law? Answer: Small businesses are businesses with less than 50 fulltime equivalent employees for the previous calendar year. You’ll sometimes see “fulltime equivalent employee” abbreviated as “FTE.” This is a very important concept. Also, your FTE count DOES include part-time employees. A part-time employee is defined as working less than 30 hours per week, and there’s a calculation when determining their “full time equivalency.” If you’re anywhere near 50 FTE, you’ll want to make sure to have this all sorted out, because there are costly tax penalties for those employers that are over 50 FTE and don’t provide health coverage.

Item #2: Know the differences between individual health plans and small group health plans.

The second important item is to know the differences between individual coverage and small group health insurance coverage. If you know anything about health insurance, you’ll know that these are two parts of the industry are completely different. They have different characteristics. There are different rules. There are different eligibility criteria. There are different tax incentives.

Depending on your business, your objectives, your budget, and other considerations… you’ll need to determine what kind of health insurance plan you want to work with: A) Individual health insurance plans, or B) A group health insurance plan.

The good news: because of healthcare reform, it’s now easier than ever before to work with individual health insurance plans to provide coverage to your employees. And in certain cases, it might even make more sense. Know how individual health insurance plans and the health insurance exchanges can work for small business.

That being said, group health insurance can still be an important option for small businesses. Group health insurance plans also have the best tax incentives, especially if employees are contributing to the plan. Physician networks are also sometimes better when working with small group health insurance plans.

Additionally, there is now a group health insurance plan called SHOP (the Small Business Health Options Program) that is available through the health insurance marketplaces. SHOP can provide tax-credits to help with premiums for qualified small businesses.

Item #3: Decide if you’re going to provide health coverage for your entire group or just yourself. 

Remember: small businesses (less than 50 FTE) are not required to provide health coverage to their employees. However, if you’re not going to provide coverage, you and your employees will still need to find an individual health insurance plan somewhere on your own. The reason? Everyone has to have health coverage or pay a tax penalty.

Determine if you have a budget for your entire group. There could be strategies that are surprisingly affordable, especially based on the size and average income of your group.

Item #4: Understand the different planning strategies for small business.

There are a variety of different planning strategies that are available to small businesses. These different strategies can utilize individual insurance plans, or group insurance plans.

Health insurance is a very basic benefit that can help you attract and retain quality employees. If you determine that you’d like to help provide coverage for your employees, you’ll want to come up with a program that fits your objectives best. Here are a few of them:

Defined Contribution Strategy: “Defined contribution” is a retirement planning phrase. It’s been around for a long time. You can Google it and read all about it. Health benefits planners are now using “defined contribution” strategies to fund healthcare. And it’s simple. It’s exactly what it says it is: you “define a contribution” (ie: $300) per month, and employees then purchase their own individual health insurance plans. Employees can pick from insurance policies that are both on or off the public health insurance marketplaces (where they may also receive substantial subsidies, based on income). This strategy is budgetable, and gets business owners out of the business of making insurance decisions. Employees make their own decisions and purchase their own plan. Effectively, all it is is an after-tax stipend. A raise.

Consumer Directed Health Planning: This can also be referred to as account based or equity based planning. Small business owners can provide their employees access to a high deductible health plan (usually a group plan), and then pair it up with an HRA (health reimbursement arrangement) or HSA (health savings account). The HRA or HSA becomes an asset that builds equity over time. You retain funds that would normally go to the insurance companies in the form of premiums, and ownership of the account stays with either the employee or business, depending on your strategy.

Small Business Health Options Program (known as SHOP): This is a new program that has been made available on both the federal and state health insurance exchanges. It was specifically designed to help small businesses (under 50 FTE) provide a group health insurance plan to their employees. Depending on income and size of your group, you may also be eligible for a sizable tax credit (up to 50% of premiums).

Item #5: Know where you have access to products, advice, customer service, and consultation.

This is the last item on the list. Know where you can find help. Find effective advisers that can help you sort everything out. A “one-stop-shop” can help you save time, money, and a lot of hassle by “outsourcing” your small business health benefits planning. It’s like having your own human resources department.

And the good news: brokers are typically compensated by the insurance companies in the form of commissions. So you don’t have to worry about broker fees, etc. Compensation is built into every single health insurance plan regardless of whether-or-not you choose to work with an adviser.

Additionally, a broker will keep you “in the know” about new products, strategies, and reforms. They should offer a broad range of products and services that will make your planning very convenient for you. Here are some of the qualities you should look for in a broker/consultant:

  • Licensed, accredited, ethical. Find consultants that are licensed by the Department of Insurance to do business in your state. Take it a step further and find advisers that have professional designations. People with these designations provide advanced knowledge, and also adhere to strict ethical standards.
  • A strong selection of reputable product choices. Your broker/consultant should offer you a wide variety of choices from reputable insurance companies.
  • Advice and consultation in non-insurance products and services. Your broker/consultant should also be offering products and services that are considered “non-insurance products.” After-all, the goal is to fund healthcare efficiently, and there are important tools that can help accomplish this besides just insurance policies. Things like HRAs (health reimbursement arrangements), HSAs (health savings accounts), COBRA administration, knowledge of tax incentives, etc. Find a well-rounded broker.

And that’s it. That’s your healthcare reform checklist for small business. By understanding the points we’ve made, you’ll be on the right path to drafting a health benefits program that fits you or your business best.

We help individuals and businesses sort everything out at Policy Advantage Insurance Services. We can help you design an effective, efficient program that fits your objectives. Please contact us anytime for a free consultation.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

 

See for Yourself: Real People. Real Results.

Helping our clients effectively navigate healthcare reform (and the health insurance industry) inspires and motivates us more than anything. Our number one goal is to help individuals and businesses improve coverage and save money. Whenever we can achieve this, it’s very fulfilling.

We go to work on each-and-every case. Whether you’re an individual or business, we’re listening to you. Depending on your current situation, we can provide you with various options so that you have choices when you’re making decisions. Every case is different, and we take great pride in helping you with your health benefits planning.

Here are some of the results. Real people. Right at Twitter.

We helped Heather navigate COBRA and saved her some big money:

Dave was one of the first to enroll at Covered California, even though the website “wasn’t working” at the time:

We helped Meagan enroll after she incurred long wait times online and over the phone at Covered California:

These are just a few of the people that we’ve helped, and we’d like to thank them greatly for their Tweets. There is nothing that motivates us more. We have a growing list of clients that we’re helping each-and-every day.

We don’t sell, we consult with a skill-set. Here are three good reasons to work with a broker:

  1. Selection: select from a “menu” of health insurance plans at the various companies we work with.
  2. “TLC”: receive valuable consultation from the best.
  3. Simplify: health insurance can be complex, let us do the heavy lifting for you.

If you (or your business) need help navigating the health insurance or healthcare reform environment, contact us today. We’re available to help you in-person, online, and over the phone: 1(800) 617-0089.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

 

 

 

Essentials: The “Need-to-Knows” About the NEW Individual Health Insurance Marketplace

NeedToKnowWith the on-set of healthcare reform, the landscape in the individual health insurance marketplace has changed dramatically. In this article, we’re going to describe what you need to know in order to navigate the new individual segment of the health insurance industry.

Before we head for the good stuff, let’s share with you a very short background on the differences between individual health insurance and group health insurance. Briefly: if you know anything about the health insurance industry at all, you’ll know that these are two completely different ballgames when it comes to plan design. There are different rules. There are different tax incentives. There are different eligibility criteria. The list goes on. That’s a whole different article.

As an individual or business owner, you’ll want to know the ins-and-outs of both the individual and group health insurance marketplaces, but let’s emphasize that we’re looking at the individual segment only here. For certain small business owners, that’ll be most important anyways.

Here are the “essentials” of the new individual health insurance marketplace. This is what you need to know:

Guaranteed Issue Mandate

This is probably the biggest “game-changer” of them all. For years-upon-years, if you were going to apply for an individual health insurance plan, you had to go through a series of health-related questions in order to apply for coverage. There were 50, 60, and sometimes 70 or more questions. If you’ve applied for individual health insurance coverage before 2014, you know what this all about.

Starting in 2014, these health-related questions are all gone. You heard that right: outta’ here. It’s still difficult for many to comprehend. There are no more health-related questions on individual health insurance applications anymore. This is what is called “guaranteed issue” in the insurance world (big insurance word). All “guaranteed issue” means, is that if you apply for coverage, you have got to be accepted.

Q: How does this change the ballgame? A: You don’t need to necessarily have access to a group health insurance plan (employer plan) anymore to apply for coverage. This is huge (especially for those with preexisting conditions).

It can’t be emphasized enough how much this has freed-up individual choice in health insurance plans. You can literally pick any individual insurance plan from any company, and apply for coverage now. And to boot: if you’re eligible for subsides at the new health insurance marketplaces (exchanges), you could see some massive subsidies that will help you pay for your premiums.

This all sounds fine and dandy, right? It is. But there are some important rules that need to be understood, and that leads us into our next important topics.

Open Enrollment Periods

In the past (before 2014), you could apply for an individual health insurance plan at anytime during the year. You could go out, you could pick a plan, you could apply for coverage… but you might be denied. Today (2014 and beyond)… there’s now an “individual plan open enrollment period.”

Q: What’s an open enrollment period? A: It’s a time-frame when you can apply for health insurance coverage. If you’ve ever worked for an employer that has a company health insurance plan, you’ll know that you’ve usually got to apply for coverage (and make changes) during yearly enrollment. This is that same exact concept in the new individual health insurance marketplace. Except it’s a BIG enrollment: it’s the entire United States.

So, that being said, you’ve now got to apply during individual insurance open enrollment each year. This can be very important, because if you miss this enrollment period, you don’t get an opportunity to apply until the next Fall. Need an appendectomy in the middle of the year? It’s too late.

The moral of the story: you want to make sure you know exactly when you can enroll in an individual health insurance plan: and that’s during open enrollment each year. That’s much different. It’s important to note that open enrollment dates are the same for individual health insurance plans both on and off the new exchanges.

Special Enrollment Period

Now that you know what open enrollment is all about, the next thing that needs to be looked at is what is called a “special enrollment period.” A “special enrollment” is a time to enroll in the middle of the year (outside of the regular open enrollment described above), under specific circumstances.

Q: What are these “special enrollment” circumstances? A: They’re described as “life events” that can take place throughout the middle of the year. If you incur one of these “life events,” you’ll then be eligible to enroll in an individual health insurance plan outside of the regular open enrollment period: called a special enrollment.

Here are some examples of these “life events”:

  • You get married.
  • You get divorced.
  • You have a child.
  • You lose your coverage (changing jobs, etc).
  • You move out of the state where you currently get your health insurance.
  • You become a legal citizen or national.
  • … plus others.

You’ll want to make sure that you understand these qualifying “life events” if you ever need to utilize the “special enrollment period.” Additionally important: most events give you 60 days to enroll in a new plan from the time the “life event” takes place. However, a few of these events only give you 30 days. Make sure you know which event applies to you, and how much time you have.

Now that we know all about guaranteed issue, open enrollment, and special open enrollment… we want to take a brief last look at a few of the basic important concepts of the new individual health insurance marketplace. They are:

  1. Shared Responsibility
  2. Minimum Essential Coverage
  3. Essential Health Benefits

Shared Responsibility

Shared responsibility” is a technical term that has been coined in the healthcare reform law. All it means is that everybody has got to be “in” in order to make these new reforms work: the federal government, state governments, employers, and individuals. The “shared responsibility” provision applies to all individuals of all ages, including children. Everybody has got to have a health insurance plan from somewhere.

Minimum Essential Coverage

Minimum essential coverage” is the type of coverage that you have got to have in place in order to satisfy the requirements of the Affordable Care Act (healthcare reform). In other words, there is a standard of coverage that has to be met in order to meet responsibilities required under the Act. If you don’t want to pay the tax penalties, you’ve got to have this “minimum essential coverage.” There are health plans that are called “limited benefit plans” that do not meet the criteria of “minimum essential coverage.” In an instance where you only have a “limited benefit plan” in place, you’d be paying premiums for this plan that doesn’t conform, and then would also end up having to pay the tax penalty.

Additionally, if you’re one of those people that saw your rates go up in your individual health insurance plan over the past year (or even saw it cancelled), this is one of the reasons why. They’ve “raised the bar” on the required benefits in health plans (for additional info, read about the “metallic levels of coverage“). For this reason, rates have gone up. If you’re a higher earner that is not receiving a subsidy at a health insurance exchange, this can be burdensome.

Essential Health Benefits

These are certain new benefits “essential health benefits” that are mandated in the new “minimum essential coverage” plans described above. There’s a series of them 10 of them. Count ‘em:

  1. Outpatient Care.
  2. Trips to the emergency room.
  3. Treatment for inpatient care in a hospital.
  4. Care before and after your baby is born.
  5. Mental health and substance abuse services.
  6. Prescription drug coverage.
  7. Services to help you recover if you’re injured or disabled: physical therapy, etc.
  8. Lab testing.
  9. Preventive services like counseling, vaccines, and screenings.
  10. Pediatric services which includes dental care.

Even though you may or may-not need some of these services, these benefits are now still required in all plans. This is another reason that individual insurance premiums have gotten more expensive, and in certain cases, cancelled altogether. If you’re not getting any help with subsidies at the exchange, this can again be a “problem area.”

That’s it. Those are the basics of the new individual insurance marketplace. These are all of the “need-to-knows” so that you can begin to navigate this segment of the health insurance industry.

Additionally, you can coordinate various strategies within the new individual marketplace, so that you can put together a health benefits program for your small business that is affordable, and that your employees will appreciate.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

 

International, Travel, & Expat Health Insurance

When you’re living or travelling abroad health insurance is not usually the first thing on your mind, but it can be a very important. If you ever need medical services while you’re in another country, you may end up paying for these services out-of-pocket if you’re not insured. That’s where a global international, travel, and expat health insurance plan can come in handy.

Policy Advantage Insurance Services partners with some of the best companies in the industry like Cigna Global and Anthem GeoBlue. With these companies you will:

  • Attain peace-of-mind when insuring with some of the world’s biggest international insurers.
  • Have access to global networks of over 1 million quality hospitals, physicians, clinics, and health specialists.
  • Custom-tailor the plan that fits you or your family best.
  • Get top-quality 24/7 customer service while you’re abroad.

Q: What is international, travel, and expat health insurance?

A: It’s health insurance when you’re traveling, working, or living abroad. It’s designed to give you and your family peace-of-mind and access to high-quality healthcare wherever you are in the world.

Q: Why would I need international health insurance?

A: In most cases, if you’re a foreign national in another country, there is a pretty good chance that you and your family won’t have access to the national health program where you’re currently residing. Additionally, healthcare services vary widely across the globe, so the standard of care that you are accustomed to receiving at home may be significantly different than what you are used to.

Q: How does coverage work when it comes to international health insurance? 

A: International, travel, and expat health insurance plans are flexible to your needs. A plan can be designed to fit your coverage necessities and budget. Core benefits include things like: inpatient hospitalizations, surgeries, and other hospital or physician services. Additional benefit options can be added like: doctor visits, prescription drugs, and even cancer treatments.

Cigna Global and Anthem GeoBlue are two of the most reputable international, travel, and expat health insurers in today’s market. Both have global hospital/physician networks and strong customer reviews; these companies can add peace of mind to your stay abroad.

Policy Advantage Insurance Services partners with both companies. If you’re planning a trip overseas (long-term or short), or are going to be working/studying abroad, contact us today for a quote. Prices can vary based where you’ll be in the world, but we’ll be sure to help you find the plan that fits you best, at the best price.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

Categories: General Benefits Info

COBRA: Enrollment Extension

May 31, 2014 1 comment

Recently, Covered California announced an enrollment extension for people that are on COBRA in California. If you’re currently enrolled in COBRA, you may already understand the costs associated with this type of coverage: it can be expensive. This enrollment extension could save you some BIG bucks.

We’re not going to explain COBRA in this post, we’re just going to explain how this recent enrollment extension works. If you’re currently on COBRA, you most likely already know what COBRA is all about.

Below the icon is some important info. If you’re on COBRA, you’ll want to know about all of this. *NOTE: Keeping it simple, if you’re currently on COBRA, talk to us so we can help you sort it out.

Here’s what you need to know:

  • This enrollment extension runs from May 15th, 2014 to July 15th, 2014.
  • If you’re currently on COBRA, you still have the opportunity to enroll in an individual or Covered California (exchange plan), as long as you do it between the above-listed dates.
  • This may save you some BIG MONEY, because COBRA extension coverage from your previous employer is expensive: you pay up to 102% of total premiums (your part + employer part + admin fees).
  • During this time, enrollment is open so you can switch from COBRA to an individual or Covered California exchange plan (either of which may be considerably less expensive than your current COBRA coverage).

If you’re currently on COBRA, here are two important questions you want to ask yourself:

  1. Am I eligible for subsidies on the Covered California exchange? If this is a “Yes” you may really want to look into switching over to an exchange plan from COBRA.
  2. If I’m not eligible for subsidies at Covered California, would switching to a regular individual plan save me money? Even if you’re not eligible for subsides on the exchange, the individual coverage you can find might be considerably more affordable than your current COBRA coverage. 

If you’re on COBRA currently, contact us so we can help evaluate your case. You could save some big money (thousands of dollars a year) by making a simple switch. Here is our CONTACT CARD. And you can call direct here: 424.442.0170.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.policyadvantage.com

Twitter: http://www.twitter.com/policyadvantage

Facebook: http://www.facebook.com/policyadvantage

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

Word Press (you are here): http://www.policyadvantage.wordpress.com

Covered California: Special Enrollment Period

April 21, 2014 1 comment

Thanks for stopping by today, we’re glad that you’re here. In this blog post we’ll be talking about Covered California’s “Special Enrollment Period.” To keep it simple, this is a period of time when people will be able to enroll in an individual or family health insurance plan outside of open enrollment if certain “life-changing events” are experienced.

Let’s review before we move on: open enrollment for the new Covered California insurance exchange recently finished up. If you’ve been following along, you’ll know that there are now open enrollment periods for individual and family plans both on and off of the new public exchange. In other words, in order to participate in an individual health insurance plan, you’ll now have to enroll during specific times each year. This is called open enrollment.

However, if you experience a qualifying “life-changing event” you may be eligible for a “Special Enrollment Period” in the middle of the year. In other words, yes: you may be able to enroll outside of open enrollment.

Here are some common examples of those qualifying “life-changing events” we described above:

  • Marriage or domestic partnership.
  • Childbirth, adoption, or placing a child up for adoption or in a foster home.
  • Changing your place of permanent residence, therefore gaining access to Covered California plans (this includes moving from another state).
  • Losing your health insurance (ie: losing or changing jobs, losing MediCAL coverage, or COBRA coverage expiration).
  • Changes in income. If you have an income change in the middle of the year, you may be eligible for more (or less) of a subsidy if you’re currently receiving assistance.
  • Becoming a citizen, national, or someone who is residing here legally. This event would only apply to those who were not previously a citizen, national, or legally residing here.
  • An “exceptional circumstance.” Covered California will determine on a case-by-case basis whether-or-not someone may be eligible to enroll via an “exceptional circumstance.”
  • American Indians or Alaska Natives. You are be eligible to change your plan (or enroll in a new plan) up to once per month even if open enrollment is over.
  • Your enrollment was wrong due to the misconduct or misrepresentation of your health insurance company, Covered California, or a Covered California entity (ie: a Certified Enrollment Counselor).

The above listed are examples of common “life-changing events” that might make someone eligible for a “Special Enrollment Period” outside of open enrollment.

Question: How long do I have to enroll if I experience one of these “life-changing events?”

Answer: You have 30 to 60 days (depending on the event). For example, if you lose your job-based coverage, you have 30 days. However, many of the other events give you 60 days. Make sure you know which event occurred, and how much time you have to enroll. 

If you think you’ve experienced a “life-changing event” and are eligible for the “Special Enrollment Period,” please contact us anytime. As a “Certified Insurance Agent,” Policy Advantage Insurance Services is able to help you find plans both on and off of the Covered California exchange (please note: the “Special Enrollment Period” rules do also apply to plans off of the exchange).

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