Life brings changes, and whether you have a new employee, or a change in hours to qualify for benefits, or even perhaps a marriage or newborn in the family, these are all "qualifying events" for special enrollment for medical insurance. Under the Affordable Care Act (ACA), there are rules when you may join or make changes to your coverage. "Open enrollment" has been around forever for large employer groups, but for small employer groups, they were able to add eligible employees at any time in MN. Individuals that applied for coverage not having major health issues and were accepted, were able to enroll at anytime, but ACA has changed that and now we are all subject to "open enrollment" windows.
An employer group plan (both large and small) has an "open enrollment" each anniversary of their renewal, and those on individual plans, have a 60 or 90 day window around the first of the calendar year. This is the time when people can enroll who have not previously been on the employer plan, or for individual plans, can change to another plan or even insurer. To enroll after an "open enrollment" period is over, or after the "waiting period" is over for a new employee, would take a "qualifying or triggering event", for a special enrollment. I have put together a chart of common qualifying events, showing the time frame for enrollment and what documentation may be required in addition to the enrollment form. Of course there are other life events that may qualify not listed here, and we would be happy to assist you in determining whether you may have a qualifying event for a special enrollment.
|Life Event||Special Enrollment Period||Effective Date||Supporting Documentation|
|New Employee||Waiting period; none, or||Immediate, or 1st||Completed enrollment form|
|usually 30, 60, or 90 days||of following month|
|after date of hire||after 30 or 60 days,|
|or 90th day|
|Newborn||60 days from date of birth||Date of birth||Enrollment form and/or birth certificate|
|Adopted child||60 days from adoption date||Date of adoption||Adoption papers or court order|
|Marriage||60 days from marriage||1st of month after||Marriage Certificate|
|Divorce||60 days from official divorce||the event and||Court documents of divorce|
|Permanent move||60 days following move||submitted enroll-||Closing documents or lease, or dated|
|COBRA exhaustion||60 days after end of coverage||1st of month after||Letter from previous carrier|
|Dependent turns||60 days from end of coverage||loss of coverage &||Termination letter from employer or|
|age 26||submitted enroll-||carrier|