Obamacare Qualifying Events

Special enrollment notes on Affordable Care Act compatible plans courtesy of Cigna:

The 2014 Open Enrollment period is coming to an end on March 31st. After that period, the Special Enrollment Period begins. The Special Enrollment Period runs from April 1st through December 31stand it allows a consumer, who experiences a qualifying event to enroll in a new health insurance plan or make changes to an existing one. A consumer has 60 days from the date of a qualifying event, including the date of the qualifying event, to apply for coverage or make a change to an existing plan. The 15th of the month is the cutoff date for a 1st of the following month effective date (see below for exceptions to this effective date). For your convenience, a full list of qualifying events is below.

An important note to be aware of: for three of the qualifying events, a paper application may be necessary for enrollment. The reason for this is the effective date may or may not be available in our quoting system. These three qualifying events are:

The birth or adoption of a baby/child – a paper application must be submitted to enroll.  If the customer is adding a newborn, the effective date will be the actual birth date. If the customer is adding a child due to adoption, the effective date is the actual placement date of the adoption.

Marriage – the earliest effective date is the first day of the following month. If the customer submits the request after the 15th of the month, the request must be done with a paper application. If the request is submitted prior to the 15th, then it can be done electronically. Remember, the customer has until the last day of the previous month to request the first of the following month. For example if the marriage was on 5/7/2014, their earliest possible effective date would be 6/1/14.

Involuntary loss of minimum essential health coverage – if the customer submits the request after the 15th of the month, the request must be done with a paper application. If the request is submitted prior to the 15th, then it can be done electronically. Remember, the customer has until the last day of the previous month to request the first of the following month. For example if the loss occurred on 5/17/14, then their earliest possible effective date would be 6/1/14.

Paper applications can be found in the Resource Center located on the CignaforBrokers portal and would be submitted via fax or mail following the process you do today for paper applications.

For your convenience, a list of qualifying, also known as triggering, events is below.

  1. An individual and any dependents who lose minimum essential health coverage (except if terminated for non-payment of premium).
  2. An individual gained or became a dependent through marriage, birth, adoption, placement for adoption, or placement in foster care.
  3. An individual experienced an error in enrollment.
  4. An individual adequately demonstrated that the plan or issuer substantially violated a material provision of the contract in which s/he is enrolled.
  5. An individual became newly eligible or ineligible for advance payments of the premium tax credit or is experiencing a change in eligibility for cost-sharing reductions.
  6. An individual or enrollee made a permanent move and new coverage is available.
  7. A Native American, as defined by section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month (this is only applicable to coverage purchased through the Marketplace).
  8. An individual, who was not previously a citizen, national, or recently lawfully present individual gains such status (this is only applicable to coverage purchased through the Marketplace).
  9. An individual released from incarceration.
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