In follow up to our last blog post regarding Special Enrollment Periods (SEP) we wanted to look further into some specific ones that are most common. The most common SEP qualification we are seeing is for individuals that have lost or will lose their health coverage from their employer.
Since we are outside of the Annual Enrollment Period you must have a qualifying life event (QLE) in order to purchase coverage on the North Carolina health insurance marketplace. If you are losing your employer health insurance involuntarily you have a 60 day window to purchase health insurance on the marketplace either before or after the event occurs. This is the only QLE that you can purchase coverage before the event occurs.
Let’s look at a few scenarios to further illustrate:
John’s employer terminates the group coverage effective May 1, 2014. John contacts us on July 15th to apply for coverage.
Result: John CANNOT purchase coverage because he is past his 60 day enrollment period and will have to wait until November 15, 2014 to apply (start of the next AEP) for coverage to start January 1, 2015 or until he has another QLE.
John’s employer terminates the group coverage effective May 1, 2014. John contacts us on April 30 and we submit an application.
Result: John can submit an application prior to 60 days of the QLE occurring. In this scenario because he did it before the new month his coverage will start on May 1, 2014 preventing any gaps in coverage
John’s employer terminates the group coverage effective May 1, 2014. John contacts us on May 15 and we submit an application.
Result: John can submit an application up to 60 days after the QLE has occurred. However in this instance his coverage will start on June 1, 2014 leaving him 1 month without coverage
As the above scenarios illustrate it is best to contact us about 30 days prior to the group coverage being lost (typically due to termination of employment, employer no longer offering health benefits, changing jobs, or dependent turning 26 and aging off parents plan).
Remember this is the only QLE that you can apply prior to the event occurring. All other QLE’s the event has to occur first then you have 60 days to apply.