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Open Enrollment for Individual Insurance Ends April 15th

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Most people do not realize that after April 15th, one will not be able to buy individual health insurance (a non employer based health plan) after April 15th for 2014.  The next opportunity to enroll will come in October and you will be effective for January 1, 2015.  So if you are waiting to get coverage – do not wait, get something now!

There are some qualifying events that will allow you to enroll off of this deadline – and if you qualify for one of these you will have the opportunity to enroll right away off of the open enrollment windows.  Here are those events:


The California On Exchange Events (Covered California)

•      A Qualified Individual or Dependent loses Minimum Essential Coverage;

•     A Qualified Individual gains a Dependent or becomes a Dependent through marriage, birth, adoption or placement for adoption;

•     An individual, not previously a citizen, national, or lawfully present gains such status;

•     A Qualified Individual’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of an error of the Exchange or HHS, or its instrumentalities as determined by the Exchange. In such cases, the Exchange may take such action as may be necessary to correct or eliminate the effects of such error;

•      An enrollee demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee;

•      An individual is determined newly eligible or newly ineligible for Advance Payments of the Premium Tax Credit or has a change in eligibility for Cost-Sharing reductions, regardless of whether such individual is already enrolled in a QHP;

•      The Exchange must permit individuals whose existing coverage through an eligible employer sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming Plan Year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan;

•      A Qualified Individual or enrollee gains access to new QHPs as a result of a permanent move; and

•      A Qualified Individual or enrollee demonstrates to the Exchange, in accordance with HHS guidelines, that the individual meets other exceptional circumstances as the Exchange may provide.

  • United States military returning from active duty or a Member of the California National Guard returning from active duty services under Title 32 of the United States Code;
  • An individual who has been released from incarceration.


The California Off Exchange Events (Private insurance market)

  •  Involuntary Loss of Minimum Essential Coverage (loss of minimum essential coverage includes loss of eligibility of coverage as a result of legal separation, divorce, cessation of dependent status (such as attaining the maximum age to be eligible as a dependent child under the plan), death of an employee, termination of employment, reduction in the number of hours of employment. Loss of eligibility does not include a loss due to the failure of the employee or dependent to pay premiums on a timely basis or termination of coverage for cause (such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the plan);
  • Gain a dependent or become a dependent through marriage, domestic partnership, birth, adoption, placement for adoption, or appointment of domestic partnership;
  •  Mandated to be covered as a dependent pursuant to a valid state or federal court order
  • Health coverage issuer substantially violated material provision of health coverage contract;
  •  Release from incarceration
  •  Access to new health benefit plans due to permanent move;
  • Loss of services from contracting provider under another health benefit plan, as defined in Sections 10965 of the Insurance Code or 1399.845 of the Health and Safety Code, for a condition described in Health and Safety Code § 1373.96(c) (an acute condition, serious chronic condition, pregnancy, terminal illness, care of newborn between birth and 36 months of age, or performance of a surgery or other procedure that has been recommended and documented by the provider) and that provider is no longer participating in the health benefit plan;
  •  Member of the Reserve Forces of the U.S. military returning from active duty or member of the California National Guard returning from active duty under Title 32 of the U.S. Code.