Guaranteed Issue

All health insurance carriers are now required to offer all of their individual market and group market plans to everyone in the state. Health insurance carriers are also required to accept any individual who applies for a policy, as long as the individual pays the premiums and follows the terms and conditions of the policy. In addition, beginning on January 1, 2014, carriers are no longer allowed to limit or exclude coverage related to pre-existing conditions. For persons under the age of 19, this provision became effective for policy years beginning on or after September 23, 2010. Coverage offered both inside and outside the marketplaces may restrict guaranteed issue coverage to certain enrollment periods. Also, all policies now include guaranteed renewability, which means policies renew or continue in force coverage at the option of the policyholder.

Enrollment Periods

There are three timeframes where individuals may enroll in a qualified health plan. They are:

1.     The initial enrollment period – begins October 1, 2013 and continues through March 31, 2014.

2.     The annual open enrollment period – between October 15 and December 7 each year, beginning in 2014.

3.     Special enrollment periods – occur throughout the year, based on individuals’ special circumstances.

Special enrollment periods allow individuals to purchase (or change) insurance plans outside of the annual open enrollment period. These special enrollment periods occur when certain triggering events take place. Some events that trigger a special enrollment period, but are not limited to:

·         Marriage

·         Birth of a child or adoption

·         Becoming a dependent

·         Gaining status as a citizen, national, or lawfully present individual

·         Loss of minimum essential coverage, such as loss of Medicaid eligibility or termination of a qualified health plan (not including failure to pay premiums)

·         Loss of affordable employer-sponsored coverage

·         Determination that an individual is newly eligible or ineligible for premium tax credits or cost-sharing reductions

  • Permanent move to an area where different qualified health plans are available
  • Other exceptional circumstances identified by the Marketplace

In most cases, special enrollment periods will extend for 60 days from the date of the triggering events. It’s also possible for a special enrollment period to begin before the triggering event takes place (such as the pending loss of minimum essential coverage due to the termination of a qualified health plan).

 

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Michael Acosta
Michael.Acosta@acostainsurance.com
305-265-8118
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