Q: Can I enroll in health insurance coverage any time I want?
A: No. If you want to buy coverage directly from a health insurance company, the company is required to offer you coverage only during an annual open enrollment period except if you have a “qualifying event” that allows you to enroll outside of the annual open enrollment period. If you have coverage through an employer, you must enroll in your employer’s health plan during your employer’s open enrollment period, although you can enroll at other times of the year if you have a qualifying event.
Qualifying events occur when a person loses coverage for one of the following reasons:
• the person is covered as a spouse or dependent on an employer plan and the employee passes away;
• the person is covered by an employer policy and the employee loses coverage because of a reduction in working hours or employment termination (whether voluntarily or involuntary);
• the person loses coverage because of a divorce or the death of a spouse or parent;
• the person becomes entitled to Social Security benefits;
• a dependent child becomes too old to stay on a parent’s plan;
• the person gains citizenship, leaves incarceration, or gains status as an Indian tribe member;
• the person moves outside his or her current insurer’s coverage area;
• a change in income or household status affects the person’s eligibility for federal health insurance subsidies or cost-sharing reductions;
• a person loses coverage because his or her employer goes bankrupt.
Marriage or the birth or adoption of a child can also be qualifying events, allowing you to add a new spouse or child to an existing plan. Also, if you qualify for Medicaid (generally available to individuals and families with incomes of less than 138 percent of the federal poverty limit), you can apply for Medicaid without restrictions at any time of the year. It is important to understand that, if you have enrolled in an insurance plan through the federal health insurance Marketplace (www.healthcare.gov
), voluntarily quitting a Marketplace plan in the middle of the year is not a qualifying event and you may be unable to enroll in another plan until the next annual open enrollment period.
Q: Do the rules about open enrollment periods and qualifying events apply to coverage under the new Affordable Care Act?
A: Yes. Under the Affordable Care Act, insurers are required to offer coverage to anyone who applies only during open enrollment periods, except when a qualifying event requires an insurer to offer coverage outside of an open enrollment period.
Q: When are the open enrollment periods if I want to buy insurance from an insurance company for me or my family?
A: If you want to buy coverage directly from an insurance company, the 2015 annual open enrollment period runs from November 1, 2015 until Janual 31, 2016. If you don't enroll in coverge during this period, you may have to wait until next year's open enrollment period, unless you have a qualifying event.
Q: When are the open enrollment periods if I get coverage from my employer?
A: When you are first hired, you may be able to enroll in employer coverage immediately or you may have a waiting period of up to 90 days. If you do not enroll at your first opportunity, you will have to wait until your employer’s next open enrollment period, which occurs once each year, and you may face tax penalties. Your employer will send you a notice before the open enrollment period about when you need to apply. If you miss your employer’s open enrollment period, you will need to wait for next year’s open enrollment, unless you have a qualifying event before that date.
Q: What are my options if I have a qualifying event?
A: You can enroll in your employer’s coverage, if available, you can buy coverage directly from an insurance company, or you may be able to convert the insurance coverage you are losing into an individual policy you can keep.
Q: If a qualifying event occurs, can I wait as along as I want to enroll in coverage?
A: No. After a qualifying event, you must enroll in employer coverage within 30 days or get individual coverage within 60 days. If you fail to do so the special opportunity to enroll ends, and you may have to wait until the next open enrollment period.
Q: If I have questions, where can I go?
Ask your employer’s human resource staff, an insurance company or an insurance agent to get more information. You can also visit the Ohio Department of Insurance website at www.insurance.ohio.gov
or call its consumer hotline at (800) 686-1526.
This “Law You Can Use” column was provided by the Ohio State Bar Association. It was prepared by Douglas L. Anderson, an attorney in the Columbus office of Bailey Cavalieri LLC.