By Douglas Anderson
Squire Patton Boggs, LLP


It is almost November, which marks the beginning of the annual open enrollment period for health insurance. As this time approaches, it is important to realize that if you want to buy coverage from a health insurance company directly, or if you have coverage through an employer, you can only enroll in health insurance coverage during this time.

That is, unless there is a “qualifying event” in your life, in which case, you can enroll at other times of the year.

Qualifying events? 
“Qualifying events” are life changes that impact your health insurance coverage. If you experience a qualifying event, you can enroll in health insurance coverage outside of the open enrollment period. A qualifying event could be if:

• You are covered by an employer policy and then lose coverage because you quit, you are fired, or you experience a reduction in working hours;

• You get divorced or lose a spouse or a parent;

• You become entitled to Social Security benefits;

• You were a dependent child, but have become too old to stay on a parent’s plan;

• You gain citizenship;

• You are released from incarceration;

• You gain status as a member of a Native American tribe;

• You move outside of your current insurer’s coverage area;

• You have a change in income or household status that affects your eligibility for federal health insurance subsidies or cost-sharing reductions;

• You lose coverage because your employer goes bankrupt.

Marriage or the birth or adoption of a child can also be qualifying events, allowing you to add a new spouse or child to an existing plan.

Additionally, if you qualify for Medicaid (generally available to individuals and families with incomes of less than 138 percent of the federal poverty limit), you can apply for Medicaid without restrictions at any time of the year. It is important to understand that if you have enrolled in an insurance plan through the federal health insurance Marketplace (www.healthcare.gov), voluntarily quitting a Marketplace plan in the middle of the year is not a qualifying event and you may be unable to enroll in another plan until the next annual open enrollment period.

Open enrollment period

Under state and federal law, insurers are required to offer coverage to anyone who applies only during open enrollment periods, except when a qualifying event requires an insurer to offer coverage outside of an open enrollment period.

If you want to buy coverage directly from an insurance company without an employer being involved, the annual open enrollment period for coverage that will become effective on Jan. 1, runs from Nov. 1 to Dec. 15. If you don't enroll in coverage during this period, you may have to wait until next year's open enrollment period, unless you have a qualifying life event.

When you are first hired by an employer, you may be able to enroll in employer coverage immediately or you may have a waiting period of up to 90 days. If you do not enroll at your first opportunity, you may have to wait until your employer’s next open enrollment period, which occurs once each year, and you may face tax penalties. Your employer will send you a notice before the open enrollment period about when you need to apply. If you miss your employer’s open enrollment period, you will need to wait for next year’s open enrollment, unless you have a qualifying event before that date.  

You have the option to enroll in your employer’s coverage, if available, or you can buy coverage directly from an insurance company. There is also a possibility that if you lose coverage from an employer, you may be able to convert the coverage to an individual policy that you can keep. Consult an insurance agent to see if that is the case.

After a qualifying event, you must enroll in employer coverage within 30 days or get individual coverage within 60 days. If you fail to do so the special opportunity to enroll ends, and you may have to wait until the next open enrollment period.    

Ask your employer’s human resource staff, an insurance company or an insurance agent to get more information. You can also visit the Ohio Department of Insurance website at www.insurance.ohio.gov or call its consumer hotline at (800) 686-1526.  

About the author

Doug Anderson is an attorney with the law firm of Squire Patton Boggs (US) LLP in Columbus, Ohio. He practices in the area of insurance law, regulation and compliance. Articles appearing in this column are intended to provide broad, general information about the law. This article is not intended to be legal advice. Before applying this information to a specific legal problem, readers are urged to seek advice from a licensed attorney.