Special Open Enrollment Period (limited to certain life change events).

Posted by Phil Dougherty
April 18, 2014

With open enrollment now over, obtaining individual or family health insurance before the next open enrollment (currently scheduled for October 15 – December 7, 2014) is only possible with certain “life change” events.  Some of these events must result in a loss of minimum essential coverage such as a divorce or legal separation, a move out of state or service area, change in employment status (i.e., reduction in hours), loss of employer coverage, or the death of a parent or spouse.  Proof of a loss in minimum essential coverage is required. 

Or, if the life change event results in gaining or becoming a new dependent such as a marriage (including domestic partners) or the birth or adoption of a child, one can also acquire new coverage outside of next open enrollment period. Proof of these changes is required as well.

Being unhappy with the coverage you obtained during the initial open enrollment period or a change in a physician’s network status* does not qualify as a special enrollment opportunity.

The state has recognized this issue and has taken some steps to assist those who are in the middle of certain treatment.  It is called Continuity of Care. Click here for the web page from the Department of Managed Health Care, which explains Continuity of Care in detail. If you think you may qualify, contact your insurance carrier to begin the process.

*Since there are two exchanges in which to acquire new insurance (Covered CA and the private exchange) and multiple plan options within the same carrier in each exchange, there are network discrepancies surfacing between carriers and providers. Always check with your provider first before making appointments to see if they accept your insurance.  In speaking with them on the phone be as descriptive as you can and have your ID card handy.

As the plan year moves along, clarification and exceptions to rules are likely. Feel free to contact me if you have a question and I’ll do my best to provide you with the latest information.

Phil Dougherty