Want to Opt out of Group Insurance? – Now you Can!

Everyday Winner.One of the major concerns for Americans with the initiation of the Affordable Care Act was whether or not individuals would be able to stay with their employer’s group plan if they so desired.  The answer is yes.  The ACA did not mandate individual coverage versus group coverage, but simply mandated minimum essential coverage for every individual.  Oftentimes, that coverage can be obtained through an employer or a group health plan.

However, with the rise in the cost of insurance, many Americans are now asking the opposite question:  must I continue with my group coverage or can I pursue a more affordable individual option for either myself or my family members?  Again, the answer is yes.  Having access to group coverage does not disqualify you from pursuing other insurance options.  In fact, enrollment in any non-calendar year group health plan is now a Qualifying Life Event.

Recently the Healthcare Marketplace extended the list of Qualifying Life Events (QLE’s), allowing more individuals to enroll in health coverage outside of Open Enrollment.  Under the ACA, a person must have experienced one of these QLE’s within the last 60 days in order to be qualified for a Special Enrollment Period, and now that list includes the enrollment periods for certain group health plans.  For instance, if your company or business offers you health insurance, during your company’s open enrollment period you will have a valid Qualifying Life Event and can at that time decide to either stay with group coverage or enroll in an individual health plan.  Keep in mind, however, you only have 60 days to complete the enrollment process if you are opting out of group coverage.

Also, be aware that although you will have a Qualifying Life Event, you may not qualify for a federal subsidy.  Having access to affordable group coverage as defined by the Healthcare Marketplace can disqualify you from receiving a premium tax credit to help you pay for your health insurance.  Keep in mind, however, that although you may not receive a federal subsidy oftentimes individual health plans are still more affordable, especially for family members.  If your company has an open enrollment period, it may be a good time to explore other options.  An individual Blue Cross Blue Shield of NC health plan could be the perfect fit!

For you or your dependents under the age of 30, for example, you can save money with a Blue Cross Blue Shield of NC Catastrophic plan. Or, you may be able to get more coverage for your dollar simply because every BCBSNC health plan includes pediatric dental and vision as an added benefit.  For these and other reasons, an individual health plan could be a wiser investment than group coverage and with the expansion of the list of QLE’s, it pays to do the research.

For more information on Blue Cross Blue Shield of North Carolina health insurance coverage, the Marketplace and healthcare gov  to apply for your subsidy, please visit our website at or call our toll free number 888-765-5400 and speak with one of our experienced and professional agents.  Let us help you navigate through the Health Care Reform changes in accordance with the new regulations of The Affordable Care Act, also known as Obama care.


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