Special Enrollment: Loss of Coverage

Below are some of the fine details as to what is required if you are trying to enroll outside of Open Enrollment and trying to use LOSS OF COVERAGE to stimulate a Special Enrollment.

  • Annual Renewal occurs outside of Open Enrollment; provide a copy of the renewal letter from existing/prior Insurance Company.
  • Divorce or legal separation results in you losing coverage under your spouse’s health insurance; provide a copy of the certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company. 
  • Employer reduces your hours, leaving you without coverage; provide a letter from your employer on Company letterhead and signed by an officer/owner of the Company.
  • Employer sponsored and/or Group coverage terminates due to non-payment of premium; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company.
  • Exhaustion of COBRA; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company.
  • No longer meets definition of dependent due to age; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company.
  • Non-payment of premium, misrepresentation or fraud; provide a copy of reinstatement denial letter OR copy of rescission letter from existing/prior Insurance Company.
  • Short Term Medical Plan is exhausted; provide a copy of termination letter from existing/prior Insurance Company.

Don’t Qualify for Special Enrollment? Buy Short Term Medical Coverage.

  • Spouse’s death leaves you without coverage under his/her plan; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company.
  • Spouse’s employment ends as well as coverage under his/her employer’s plan for you and/or your dependents’; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company.
  • Termination of employer contributions; provide a letter from your employer on Company letterhead and signed by an officer/owner of the Company.
  • You and/or your dependents’ have a health claim that would meet or exceed the plan’s lifetime limit on all benefits; provide a copy of Explanation of Benefits from existing/prior Insurance Company indicating that all lifetime limit on all benefits have been met or exceeded.
  • You and/or your dependents permanently move to another state and/or no longer live or work in the existing/prior plan’s service area.  Please provide the following:  1-Your prior residential address; 2–Proof of your current residential address by providing ONE of the following:  Mortgage Bill / Renter’s Agreement with new residential address, Driver’s License with new residential address OR Utility Bill with new residential address 3AND A copy of certificate of creditable coverage OR termination letter from existing/prior Insurance Company to validate the loss of coverage due to the Relocation.
  • You and/or your dependents are no longer eligible for eligible for CHIP (Children’s Health Insurance Program), Medicaid, PCIP (Federal Pre-Existing Condition Insurance Plan) or State High Risk Pool; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company and/or federal or state agency.
  • Your employer decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time); provide a letter from your employer on Company letterhead and signed by an officer/owner of the Company.
  • Your employment ends as well as coverage under your employer’s plan for you and/or your dependents’; provide a copy of certificate of creditable coverage OR a copy of the termination letter from existing/prior Insurance Company

3 thoughts on “Special Enrollment: Loss of Coverage

  1. There are a lot of things in the healthcare act that can arguable be good or bad. There is the new regulation on pre-existing conditions. Where anyone nineteen or younger can’t be denied or limited benefits. Although the law doesn’t protect those twenty and over with the same pre-existing conditions, allowing them to be denied or given limited coverage. This is wonderful for families and children but does nothing for the elderly and adults whose illness might still go uncovered. The law also extends the age a parent can insure a child to the age of twenty-six. This will let you choose wither you would like your own plan or to keep your existing one. If you miss the enrollment period or don’t sign up sixty days before your birthday you may start incurring fees, so keep a close eye on the calender and know when to start your own plan.

    There hasn’t been any real change in the policy over out of net work er visits. You still can’t be denied service and your insurance company doesn’t have to cover out of net work visits. Your insurance provider only needs to cover the percentage mentioned in your policy. You are no longer required to have your primary doctor refer you to an OBG-YN, and can choice anyone in your net work. This amendment does little for male policy holders. Insurance companies are now required to explain your policy in plain English or language you request, if they refuse they can be fined up to a thousand dollars.(sec. 2715. pg 16. line (d)(3)).

    The quality heath care requirements do not need to be met by the insurer if you are obese, have heart disease, or smoke. As long as the insurer offers free counseling and other programs to help stop or prevent these issues. (sec. 2717.) As you look closer at the health law you find that insurers penalties are the lest server for each offense, personal, and business penalties are considerably harsher. The current law as shown through healthcare.gov does very little to improve coverage for those over nineteen. It still allows insurance providers to penalize you for pre-existing conditions and poor heath choices. Lying on your application allows for termination of coverage or denied coverage. So if you check non smoker for your twenty year old collage student, later to find out they started smoking and developed lung cancer they can be denied coverage. Children with pre-existing conditions premiums will increase after the age of nineteen or can be terminated after assessment.

    1. Pham, most of your comment is invalid. Pre-existing conditions are a thing of the past, no matter what age. Also “elderly” have coverage with Medicaid or Medicare.

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