When the Affordable Care Act was introduced, it included guaranteed issue for applicants. What does that mean? Previous to January 2014, your health insurance application could be denied for medical issues. A BMI ( body mass index ) over 30 could cause you to be declined or rated up in cost. Breast inplants could also cause a declination. Sore backs, knee replacements, ear infections, unrepaired hernia are just a few of the conditions that I have encountered with clients who have had applications denied. When an insurance company offers guaranteed issue they do not want a member waiting for a surgery and then quickly apply for the insurance plan. That would be called financing NOT insurance. This is why open enrollment rules were enacted. Qualifying events are issues that allow you to enroll between the open enrollment windows.
Qualifying events include Permanent Relocation, Gaining a dependent, Court Order, Employer discontinues health coverage, Immigration Status Change, and losing your employment. My strong suggestion is to call and find out if you have had a life changing event and lose your coverage. Qualifying Event rules vary. In a few circumstances you may have 60 days. But don’t count on it. As soon as you experience what you think is a qualifying event, CALL! The standard time is quoted as 30 days. However if your QE falls after mid month, you cannot wait 45 days! My advice is to act quickly. Just call our agency to find out if you have had a QE and what is your time frame to enroll.
The next open enrollment for all individual health insurance plans, including Covered California is November 15, 2014 to February 15, 2015. That means if you applied in November, your coverage would not begin until January 1, 2015
Most importantly, these open enrollment rules apply to private plans and Covered California plans. my next blog will address the differences and why you should consider private plans that are identical to Covered California plans.