What is Special Enrollment and How to Qualify?

 

From November to January, life can get overwhelmingly busy for most. The rush of the holidays takes over, and then before you know it, you’re toasting to a new year. Through all the madness, it is also conveniently time to decide what to do about health insurance. If you do not have coverage in place, or if you are looking to get new coverage, the options might seem a little confusing or overwhelming. Knowing when you can apply and how to apply is a crucial step to getting the coverage you need when you need it. The California open enrollment period lasts from November 1st to January 31st. In that time, you are free to apply for healthcare under mostly any circumstance.

So, what happens if you miss this deadline? February 1st officially signifies a period of time called Special Enrollment. During this time, you may only obtain health coverage if you meet specific criteria. The following are some examples:

  • Loss of minimum essential coverage
  • Reduction of hours or termination of employment
  • Divorce from or death of a subscriber
  • A child meeting the age limit for coverage (i.e., 26)
  • Having or adopting a child
  • When existing coverage through an employer-sponsored plan will no longer be affordable
  • Being recently released from prison
  • Acquiring citizenship

 

A call to a health insurance agent is an easy way to determine your status. The next step is to provide proper documentation to show that you qualify for your given circumstance. There are some additional qualifying events that apply to more complex situations such as experiencing a medical crisis or a natural disaster that has prevented you from being able to apply, or technical errors and misinformation experienced while trying to obtain insurance. Most of the time, any qualifiing event needs to take place within 60 days of you applying for coverage.

For any of your health insurance needs, the Fairfax team would be happy to help! Any inquiries can be made via telephone (323-800-2239) or through our website via the quote request portal.

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Kristen Nadel is a broker/agent at Fairfax Insurance Services.

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