What is a special enrollment period under the Affordable care Act?
Under the Affordable Care and Patient Protection bill monikered as Obama care introduced some health care reforms under the guidance of the Then president of the United States of America Barak Obama. The legislation launched in March 2010. The bill made an expeditious journey in the health and medical segment of the country. The Obama care law observed a rapid surge in the health insurance sector of the nation. Research reported that more than 20 million people got enrolled for a health insurance plan under different segments of ACA like Medicaid, Medicare and CHIP.
Moreover, the bill made it mandatory for every American to have a healthcare scheme. To get register or enrolled for a medical insurance program through the federal government marketplace a certain point of time in the year got ascertained as the period of enrollment popularly known as Open Enrollment Program. Each year around three months this Open enrollment period or in short OEP happens. OEP is the official time frame for enrolling in an insurance plan. Past studies conclude that many people have enrolled through OEP. But what happens if someone misses the tenure of Open Enrollment Program? For those who have lost this tenure can register or sign up through SEP or Special Enrollment Period. Let us now learn in details about the Special Enrollment Period.
What is Special Enrollment Period or SEP?
A Special Enrollment Period allows a person dwelling in America to sign up for ACA registered healthcare plans. This tenure enables for registration only if a person has a qualifying life event. Standard purchase or registration of insurance coverage is only possible through the Open Enrollment Period held annually. Under this Special Enrollment tenure, a person usually covered for sixty days following to the occurrence of the live event.
Instead of the popularity of SEP the segments or centers for Medicare and Medicaid Services (CMS), a section of the Health and Human Services (HHS), has made specific changes as of 2016.
What is a life event that can qualify for SEP?
A life event under ACA that qualifies a person for enrolling through Special enrollment schedule mentions specific categories that can be eligible or represent a person going through a life event. The particular types of life event are-
i) The death of any person in your health insurance plan that causes you to lose eligibility for your current health insurance coverage.
ii) Medical insurance coverage may resume as soon as you adopt a child, have a baby or having a foster child with you. The insurance coverage will begin from the particular moment. And this is an essential life event as stated under the Obama care health reforms.
iii) Losing a competent health insurance coverage while getting married or divorce.
iv) If an individual has lost qualified health coverage provided by the government like health insurance plan like Medicaid, Medicare or it may be the Children Health Insurance Program or in short CHIP.
v) Life event may occur if you are trying to change your home address or trying to relocate to the United States from a foreign land. It may also happen if you move to attend school or transfer from a location for performing work.
vi) A person is also eligible for SEP if he or she have experienced a natural disaster during the tenure of Open Enrollment program or have survived through a severe ailment or medical condition.
Who does not require a SEP to enroll their names for health insurance coverage?
In some situations or cases under the Affordable Care bill, a special enrollment program or a qualifying life event not required. The conditions discussed below-
i) If a situation occurs to someone where the brink of Medicaid eligibility ends and exchange subsidy qualification starts, there may be some changes during the year, when slight income fluctuations result in a difference in ability.
ii) Special provision in the Affordable Care Act states that native Americans or natives of Alaska have the arrangement to enroll anytime during the year and need not attain annual Open enrollment tenure or SEP. Moreover, it states that Native Americans or Natives of Alaska may also change from one qualified health plan to another up to once per month.
iii) Employers have the option to select or chose SHOP plans year-round. Employees working in such an organisation can avail the same annual open enrollment opportunities.
What is the requirement behind creating a Special Enrollment Program?
A steep rise in health insurance enrollment numbers observed as per the reports of CMS or Centre for Medicare and Medicaid services during Open Enrollment Period of every year. But facts and figures further establish the case that due to the provision of Special Enrollment Plans or SEP the United States of America under the Obama health care reforms have witnessed a rapid increase in medical insurance enrollment numbers.
As per CMS, the agency pledged for the country’s health, and the medical care system published an estimation which shows that around 9,44,000 people enrolled in insurance plans through SEP in 2015.
Check your eligibility for your own SEP.
SEP is available for individuals around the year. You can apply for a health insurance plan whenever you become eligible for it as per the conditions stated under a SEP of the Affordable Care Act. This tenure is specially made available to those individuals who have adrift their coverage at any time of the year. Generally, within sixty days of a qualified life event, a person becomes eligible for applying through SEP provision.
If you do not categorize under a qualified life event as mentioned under Special Enrollment Plan, you can only enroll or register for a plan complying with the Affordable Care bill norms. And to apply for health insurance policy through ACA, you will have register through OEP or Open Enrollment Program.
As per the facts issued regarding SEP provision of the Obama care health reforms, this tenure or provision have indeed helped many of the Americans with special needs to register for a health insurance plan.