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Can I Enroll in Health Insurance? – Understanding Special Enrollment

Student thinking with question marks on blackboard. Asian femaleBy now, most of us have heard the terminology, but what exactly is a Special Enrollment and what constitutes a Qualifying Life Event?

Under the Affordable Care Act, there are two different periods in which an individual may apply for health insurance.  The first is referred to as Open Enrollment and during this time any person may apply for health coverage for any reason, as well as make changes to any existing health insurance policy.  During Special Enrollment, however, there are more restrictions and a person is required to have what is referred to as a Qualifying Life Event (QLE) in order to acquire health insurance.  If you do not have one of these Qualifying Life Events, you may not purchase health insurance during Special Enrollment and must wait until the Open Enrollment Period, which begins November 1, 2015 and runs through January 31, 2016.  If you enroll during Open Enrollment, your health plan will not become effective until January 1, 2015 or later depending on the date of your application.  Keep in mind, this is not a Blue Cross Blue Shield of North Carolina policy, but rather a policy of the federal government under the Affordable Care Act with which BCBSNC must comply.  For uninsured individuals without a QLE, temporary insurance is a smart option while you wait.

For others, a Qualifying Life Event may have occurred in which case you may be eligible to enroll in health insurance now.  A Qualifying Life Event is a specific circumstance that has altered your life and created an opportunity for you to enroll in health coverage—and there are strict guidelines to determine exactly what qualifies.  For example, a recent  marriage, adoption, or birth of a child are all events that would make you eligible to enroll in health coverage during a Special Enrollment period, so long as you enroll within 60 days of that life altering event.  Losing previously held health insurance involuntarily is another example of a Qualifying Life Event, as is a move to North Carolina or a move to a different county within North Carolina. If your income increases so that you are no longer eligible for Medicaid, you are also able to enroll in new coverage during a Special Enrollment Period.  Because the list of Qualifying Life Events is so varied, however, it is worth investigating whether you qualify to enroll during a Special Enrollment period.

It is important for you to understand what constitutes a Qualifying Life Event because it can have a huge impact on your ability to purchase health insurance or make changes to your existing policy.  In addition, the effective date of your coverage will depend on your QLE and the date of your application.

For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obamacare. Call us for details.

Tags: ACA, BCBSNC, qualifying life event, Special Enrollment

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