Special enrollment periods are any time outside of the open enrollment period when you can sign up for health insurance. In this article, we cover the basics of what a special enrollment period is. Additionally, we look at why and how you can get a special enrollment period.
Depending on your special enrollment period type, you may have sixty days before or sixty days after the event to enroll in a plan. If you miss the deadline, you may have to wait until the next open enrollment period to apply. You can enroll in Medicaid or the Children’s Health Insurance program (CHIP) any time of year. That is, only if you are eligible. Whether you qualify for a special enrollment period or not does not matter. Job based plans must provide a special enrollment period of at least thirty days.
Types of Special Enrollment Periods
There are two types of special enrollment – upon loss of eligibility for other coverage and upon certain life events.
Declined at First
Under the first, employees and dependents who decline coverage due to other health coverage and then lose eligibility or lose employer contributions have special enrollment rights. For instance, an employee turns down health benefits for her family because they already have coverage through her spouse. Coverage under the spouse’s plan ceases. That employee than can request enrollment in her own company’s plan for herself and her dependents.
Under the second, employees, spouses, and new dependents are permitted to special enroll because of marriage, birth, adoption, or placement for adoption. For both types, the employee must request enrollment within thirty days of the loss of coverage or life event triggering the special enrollment. A special enrollment right also arises for employees and their dependents who lose coverage under state Children’s Health Insurance Program (CHIP) or Medicaid or who are eligible to receive premium assistance under those programs. The employee or dependent must request enrollment with in sixty days of the loss of coverage or the determination of eligibility for premium assistance.
Events That Cause a Loss of Eligibility For Coverage
Loss of eligibility for coverage may occur when:
- Divorce or legal separation results in you losing coverage under your spouse’s health insurance
- A parent’s plan no longer covers a dependent.
- Your spouse’s death leaves you without coverage under his or her plan
- Your spouse’s employment ends, as does coverage under his employer’s health plan
- An employer reduces your work hours to the point where you are no longer covered by the health plan
- You plan decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time)
- You longer live or work in the HMO’s service area
These should give you some idea of the types of situations that may entitle you to a special enrollment right.
How To Request
Requesting a special enrollment period might be necessary depending on what triggers your need for one. The employee or dependent must request enrollment within thirty days of losing eligibility for coverage after marriage, birth, adoption, or placement for adoption.