We have new rules on how the California health insurance market functions.
One of these has to do with people enrolling outside of Open Enrollment for Individual and Family coverage.
The enrollment period for the new individual and family health plans in California is much more structured than before and we want to provide guidance on SEP's or Special Enrollment Periods.
Let's first discuss the open enrollment window, why it's so important not to miss it, and how the SEP's allow enrollment outside this period.
You can always run your Covered Ca quote with SEP here:
Each year, there will be a period of time during which a person can enroll in a California Exchange or non-Exchange plan guaranteed issue (regardless of health).
The first enrollment window was from Oct 1st through March 31st (6 months) with the earliest possible effective date being Jan 1st.
What happens if you miss this window and want to enroll in coverage? If you do not qualify under a SEP, you may be out of luck until the next window.
Let's look at what these qualifying events are.
Here's the list of SEP's which we found within the Covered California website as part of the application:
We expected the bulk of these as they are pretty common on the group health insurance side from enrolling outside of anniversary month.
This is one of the SEP's but there's a special caveat for loss of coverage.
The other events generally follow the standard effective date rules:
You can access the online application with Special Enrollment Period here:
To make guaranteed issue work, they had to build in an open enrollment window and outside of the events listed above, you will probably not be able to secure full health insurance until the end of a given year.
Don't miss the windows and events.
We don't know if the current safety nets (MRMIP, PCIP, etc) will be available as the Exchange is built to replace or consolidate most of these.
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