In the insurance industry, ‘annual enrollment’ refers to the period every year where individuals can sign up for an insurance plan with no discrimination or reduced discrimination against pre-existing conditions, or reduced or non-existent medical underwriting.
Insurance companies limit open enrollment to specific times every year in order to protect themselves and everyone else enrolled in their plans against adverse selection, which is the tendency of healthy people not to sign up for insurance until they actually have a claim. By restricting access to insurance programs outside of open enrollment periods, the carriers can prevent new enrollees with medical issues or other risk factors from taking advantage of the system and unfairly passing on their own expenses to other policyholders.
The Affordable Care Act
For those who want to enroll in an Affordable Care Act insurance plan via the exchanges, the open enrollment period is November 1, 2015 through January 31, 2016. If you enroll between these dates, the insurance company cannot turn you down because of your medical history or pre-existing medical condition. If you fail to enroll during this window, access to the plans will be restricted for the rest of the year.
There are exceptions to the open enrollment period, however. You may be able to enroll if you lost your employee health benefits, you moved to another state, you got married, widowed or divorced, gave birth to or adopted a child, you got rejected from Medicaid or CHIP, you became a citizen or legal resident and newly qualified for coverage, or you had a change in income or disability status.
Medicare Open Enrollment
The open enrollment period for Medicare is October 15ththrough December 7th. This is the window during which those over 65 or who otherwise qualify for Medicare may enroll in or make changes to their Medicare plan. Failure to enroll in Medicare during your initial open enrollment period may result in denial until the following open enrollment period, and/or increased premiums. Open enrollment requirements apply to Medicare Parts A, B, C and D alike.
Medicare supplement plans, also known as “Medigap” plans, also have open enrollments.
Employer Health Plans
Most employer health plans will provide an opportunity to enroll in the company health, disability or long-term care plans upon hire, or within 30-90 days of initial hire. If you don’t enroll during your initial open enrollment period, you may have to wait until the general open enrollment period. Every company and every plan is different in this regard. Dates may vary, and open enrollment periods may be just a couple of weeks long or as long as 90 days.
Usually, the open enrollment period is the only period you are normally allowed to make changes to your workplace insurance plan as well, So if you want to add a family member to your plan, or switch from an HMO option to an indemnity insurance plan, you will normally have to do so during the open enrollment period – unless you go through a qualifying life event. That is, you can normally enroll a family member or make changes if you do so within a certain number of days of getting married, divorced or otherwise loses coverage formerly received via a spouse’s plan, has a child or adopts.
Speak with your supervisor or employee benefits professional at your workplace, or contact us if you have more questions.
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