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Affordable Care Act Special Enrollment Qualifications

Now that Open Enrollment for the Affordable Care Act has ended, the only way to enroll in coverage is if you have a life event.  The Special Enrollment will trigger a 60-day enrollment period, but the effective dates for enrollees can change depending on the situation.

Adding a Dependent by birth, adoption, or foster care:

  • If the policyholder is already enrolled in a BCBSIL policy and wishes to make plan changes, the effective date is the first day of the month of the event for all members except the applicable dependent.

    Example: If a policyholder wishes to add a newborn (born April 16), she may also elect to change their policy during the Special Enrollment period. If a policy change is made, the newborn’s effective date would begin on the date of birth (April 16) and the policyholder’s previously covered members’ effective date would begin on the first of the month (April 1).

  • If a Special Enrollment opportunity exists, individuals also have the option to enroll in a policy for the first time for the whole family (IRS-approved tax family) and not just the new dependent. This means that an individual and/or family who may not have had prior coverage will now have the opportunity to enroll in a policy. The whole family can retroactively receive this new policy back to the first day of the month in which the event occurred. The new dependent will be pro-rated.

    Example: If a newborn is born on April 16 to a family that is not covered under a health insurance policy, the whole family is now eligible for a Special Enrollment opportunity. The effective date for the enrollees will be April 1 and the newborn’s coverage will be pro-rated to April 16.

  • If the policyholder is already enrolled in a BCBSIL policy and simply wishes to add the new dependent, the effective date will be the date of the event.

    Example: If a newborn is born April 16 to a covered policyholder, and the policyholder does not wish to make any policy changes, the effective date for the newborn will be April 16.

Marriage:

In the event of marriage, a Special Enrollment period will allow an effective date of the first day of the month after the marriage.

Example: If a marriage occurs on April 16, the effective date of coverage will be May 1.

Loss of Eligible Coverage:

In the event of a loss of eligible coverage from legal separation/divorce, Cessation of dependent status, Death or Termination/reduction of working hours with employer, a special enrollment period will allow an effective date of the first day of the month following the life event.

Example: If you lose your job on April 12th and apply for coverage on April 14th, your effective date of coverage will be May 1.

COBRA Coverage Ends:

In the event that COBRA coverage benefits run out, there is a 60-day special enrollment period that is generated after the benefits run out.

Example: COBRA ends on April 1 and application is sent in on April 5.  Application would be effective May 1.

Employer Ceases Contributions Either to Subscriber or Dependents:

In the event that an employer ceases contributions to either the subscriber or their dependents a special enrollment period is generated.  The policy would become effective the first day of the month following the event.

Example: Contribution stops from employer on March 2 and application is submitted on March 20.  In this case the policy would still be effective April 1.

Permanent Move:

In the event of a permanent move, a special enrollment period will begin.  In this case, there is a deadline of the 15th of every month for coverage to begin on the 1st of the following month.

Example: If you move on March 3 and apply on March 10, your coverage is effective April 1.  If you apply on March 16, your coverage is effective May 1.

Enrollment in Non-Calendar Year Policy Ends

In the event of a policy you currently are enrolled in ends, when it is not on a calendar year, you qualify for a special enrollment period.  The period begins 30 days prior to the end of the policy and the policy will be effective on the date of the event.

Example: You are on a policy that terminates on April 30.  Application sent in on March 14.  Policy effective 4/1.

If you have any questions on a special enrollment period, please contact Associated Agencies at (847) 427-3443.