For those who need to enroll in a new healthcare plan, or change from one plan to another, Open Enrollment is the time to complete those tasks. More to the point, unless special circumstances apply, you can only enroll in a plan or make changes during this time. Therefore it is extremely important to anticipate your Open Enrollment period, and be ready to complete the process during that window of time.
But wait! You might have noticed that there is more than one Open Enrollment period for health insurance. You will need to understand which enrollment window applies to your situation, and then complete the correct steps to select a health insurance plan.
Individual Open Enrollment. This enrollment period applies to the general health insurance marketplace for individuals – that is, people who are not covered by health insurance through their employers. In California you will complete your enrollment through Covered California, either online, over the phone, or with assistance from an independent health insurance broker.
This year, Open Enrollment for individuals runs from November 1 to December 15, 2019. Coverage under your new plan will begin on January 1, 2020.
Group Open Enrollment. Your initial enrollment period for group health insurance will occur at the time you become employed and eligible for that company’s healthcare plan. From that point on, Group Open Enrollment occurs annually upon the anniversary of the company’s enrollment in the plan. So, for example, if an employer originally enrolled in a group policy on October 1, 2015, their Open Enrollment period will occur on the first of October every year thereafter.
When you experience a change in your circumstances, allowing for a change to your plan (you get married or have a baby, for example), you can make that alteration to your plan at the time it occurs.
Contact your human resources department for more information on your group health insurance plan, or to make necessary changes to that policy.
Special Open Enrollment for Small Groups. The Affordable Care Act acknowledged that many smaller employers might want to offer a group health insurance plan, but do not meet standard employer contribution or employee participation ratios. For those cases, the Special Open Enrollment for Small Groups window exists, and will run from November 15 to December 15. Eligible small groups will receive coverage beginning January 1.
In the context of small group health insurance, an employer cannot require employees to enroll unless they cover 100 percent of the employee’s premiums.
Have more questions about Open Enrollment? Give us a call, and we will help you determine what you need to do next.