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ACA Qualifying Events

Posted on March 11th, 2014

Can people apply for individual health coverage after Mar. 31, 2014? 

Only those individuals that experience a qualifying event can sign up for a qualified health plan mid-year after March 31stMost qualifying events will create a special enrollment period that lasts for 60 days. 

Qualifying events that have been identified by the Affordable Care Act (ACA):

  1. Involuntary loss of minimum essential coverage, for example, because of a job loss  (voluntarily terminating coverage or policies that are cancelled for non-premium payment are not qualifying events)
  2. Change of family structure (i.e. marriage, divorce, death, newborn)
  3. Gaining citizenship or permanent resident status
  4. Becoming newly eligible for a premium or cost sharing subsidy (generally results from mid-year income changes)
  5. Becoming ineligible for a premium or cost sharing subsidy (generally results from mid-year income changes)
  6. Change of residential address that results in new health plan options available
  7. Did not enroll during the open enrollment period because of a mistake, misrepresentation or inaction of an officer, employee or agent of the Health Insurance Marketplace
  8. The insurance company substantially violated a material provision of its health insurance contract
  9. The individual is a member of an American Indian Tribe (can enroll or make a plan change one time per month)
  10. The individual can demonstrate to the Health Insurance Marketplace that he/she has other extenuating circumstances that qualify him/her for special enrollment

Note: The next ACA annual enrollment period will occur between Nov. 15, 2014 and Feb. 15, 2015. During this time period anyone can sign up for an individual health plan including those people that haven't experienced a qualifying event.

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The materials contained within this communication are provided for informational purposes only and do not constitute legal or tax advice


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