Enrollment Periods and Qualifying Events
Why can't I sell major medical year round?
You can sell major medical policies year round, but only under special circumstances. Under the rules of President Obama's Affordable Care Act, individuals can only purchase subsidy-eligible health insurance policies during the Major Medical Open Enrollment period.
- Qualifying Life Event
- Children's Health Insurance Program (CHIP)
For 2014 policies, the Open Enrollment period ends on March 31, 2014. For 2015 policies, the Open Enrollment period begins on November 15, 2014 and ends on February 15, 2015.
What is the Special Enrollment Period and who can purchase plans during this time?
The Special Enrollment Period is the time outside of Open Enrollment that allows individuals and families facing special circumstances (Qualifying Life Events) to enroll in a Qualified Health Plan. Most eligible individuals have 60 days to enroll after their triggering event. If they do not enroll during that 60 day window, they must wait until the next Open Enrollment to purchase a policy.
What are considered Qualifying Life Events?
- Birth, adoption, or placement of a child in your household
- Permanent relocation to an area offering different plan options
- Loss of other health coverage (examples include: job loss, divorce, loss of Medicaid or CHIP eligibility, expiration of COBRA coverage, a health plan becomes decertified). Note: The following are not considered loss of coverage: voluntarily cancellation, termination of a health plan as a result of missing premium payments, or losing coverage that is not minimum essential coverage.
- Change in income or household status that affects tax subsidy eligibility or cost-sharing reductions of a current Marketplace plan
Can I sell any other plans outside of Open Enrollment?
Yes, agents can still sell short-term medical, fixed indemnity/limited benefit, Medicare Advantage (only during the Annual Enrollment Period: October 15th - December 7th), and Medicare Supplement.