An extended “Special Enrollment Period” was announced by The White House to allow more time to finish health insurance enrollments with glitches or other special circumstances. The Health Exchange Marketplace was flooded with last minute on-line enrollments as the Open Enrollment Period closed on March 31, 2014. If you attempted to enroll but couldn’t complete the process because of any number of technical problems this Special Enrollment Period may apply to you.
As the Open Enrollment for 2014 Marketplace coverage is now over, you can only enroll in a private health plan through the Marketplace if you qualify because of a qualifying life event like having a baby, getting married, or losing other coverage or special enrollment period.
SPECIAL ENROLLMENT PERIOD
Below are cases and examples that may also qualify you for a special enrollment period according to information posted to Healthcare.gov.
You faced a serious medical condition or natural disaster that kept you from enrolling. For example:
- An unexpected hospitalization or temporary cognitive disability
- A natural disaster, such as an earthquake, massive flooding, or hurricane
- A planned Marketplace system outage, such as Social Security Administration system outage
Your application was stopped due to specific error messages. For example, you received a "data sources down" error message or another error message that didn’t allow you to enroll.
You’re working with a caseworker on an enrollment issue that didn’t get resolved before March 31.
Your application may have been rejected by the insurance company’s system because of errors in reading the data, or some of the data was missing or inaccurate.
Other system errors
Other system errors that kept you from enrolling, as determined by the Centers for Medicare & Medicaid Services
Misinformation or misrepresentation
Misconduct by a non-Marketplace enrollment assister (like an insurance company, navigator, certified application counselor, or agent or broker) resulted in you:
- Not getting enrolled in a plan
- Being enrolled in the wrong plan
- Not getting the premium tax credit or cost-sharing reduction you were eligible for
System errors related to immigration status
An error in the processing of applications or system caused you to get an incorrect immigration eligibility result when you tried to apply for coverage.
Display errors on HealthCare.gov
Incorrect plan data was displayed at the time that you selected your health plan, such as benefit or cost-sharing information. This includes issues where some consumers were allowed to enroll in plans offered in a different area, or enroll in plans that don’t allow certain categories of family relationships to enroll together.
If you applied for Medicaid through your state, or were sent to Medicaid from the Marketplace, but you weren’t eligible for Medicaid.
Your state transferred your information to the Marketplace but you didn’t get an answer about your eligibility and/or didn’t get enrolled before March 31.
Victims of domestic abuse
You’re a victim of domestic abuse and weren’t previously allowed to enroll and receive advance payments of the premium tax credit separately from your spouse. You’ll be able to do so now.
IF YOU THINK YOU QUALIFY FOR A SPECIAL ENROLLMENT PERIOD
Call AMERICAN INSURANCE at 208-746-9646 or 1-800-735-6355 and talk with one of our licensed and registered health agents. They are trained to resolve many of the problems you may be experiencing and have contacts within the Idaho Federally Assisted Exchange (Your Health Idaho) and Washington State Health Exchange (WA Healthplanfinder).
The representative will ask for information about your situation to determine if your circumstances qualify you for a special enrollment period. The representative will help you apply and enroll in coverage.
If you’re already enrolled in a plan and you get a special enrollment period, you can stay in your current plan in most cases, or you can switch plans. In some limited cases, you may qualify for an earlier effective date of coverage. Remember, you must make the first premium payment before your coverage becomes effective.
If needed, you will be directed to the Marketplace Call Center at 1-800-318-2596.
FILING AN APPEAL
If your request for a special enrollment period is denied, you can file an appeal. If the denial is found incorrect, you can get coverage back to the date your special enrollment period was denied. How to file an appeal: Select your state’s appeal form, download it, and fill it out
- Mail your appeal to:
Health Insurance Marketplace
465 Industrial Blvd.
London, KY 40750-0061