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When Can I Enroll in a Plan Through Washington Healthplanfinder?

Authored By: Northwest Health Law Advocates
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When is Open Enrollment? Do I Qualify for a Special Enrollment Period?

The next open enrollment period for Qualified Health Plan (QHP) begins November 1, 2016 and closes January 31, 2017.  A QHP is a private health insurance plan with or without financial assistance purchased on the Washington Health Benefit Exchange through Washington Healthplanfinder. Outside the open enrollment period, you can enroll in a QHP only if you qualify for a special enrollment period.

A Special Enrollment Period (SEP) allows you to enroll in or change health coverage outside of an open enrollment period for coverage during the current year. To have a SEP, you must have a “qualifying event” or “special circumstance” like having a baby or losing other health insurance.If you experience one of these events, described below, you may be able to enroll outside open enrollment.

Note:

  • You can apply for and enroll in Washington Apple Health (Medicaid) ANY TIME during the year.
  • American Indians/Alaska Natives who are enrolled members of a federally recognized Tribe or Alaska Native corporation can apply and enroll ANY TIME during the year. They also can change QHPs outside of the open enrollment period.   
  • These rules do not apply to Washington Healthplanfinder Business. Enrollment dates are set by your employer.

Who can apply or change plans before the next open enrollment period?

If you do not currently have QHP coverage, you can only enroll in a QHP outside of the open enrollment period if you have a qualifying event or special circumstance.[1] In most cases you must report the event and enroll no later than 60 days from the date of the qualifying event, which include:

  • You add a dependent or become a dependent through:

o   Marriage, birth or adoption

o   Placement in Foster Care

o   Receipt of a court order (including a medical child support order)

  • You lose other health care coverage involuntarily, for reasons including losing a job or job-based coverage (including coverage through a family member’s employer), losing eligibility for Washington Apple Health, losing eligibility for a student health plan, aging out of a parent’s plan, your COBRA coverage expires, or your health plan is discontinued mid-year.
  • You move permanently to Washington from out of the United States, or you move from a different state or within Washington and you had health insurance within the last 60 days.

If you currently have QHP coverage and want to change plans, you also must have a qualifying event or special circumstance, which include those listed above and these additional ones:

  • You lose a dependent or dependent status through death, divorce or legal separation
  • You or your dependents have a change in income or household status that makes you newly eligible or ineligible for tax credits, or changes your eligibility for cost-sharing reductions.

For a complete lists of qualifying events and special circumstances, visit: http://www.wahbexchange.org/new-customers/who-can-sign-up/special-enrollment-period/

Not included: Voluntarily dropping other health coverage, losing other coverage for not paying your premiums, or losing coverage that is not “minimum essential coverage” under the health reform law.

What should I do if I think I qualify for a Special Enrollment Period?

In most cases, you have 60 days from the date of a qualifying event to apply for coverage.

  • Visit Healthplanfinder: You can report the qualifying event or special circumstance that you think qualifies you for a SEP at: https://www.wahealthplanfinder.org. If you need assistance, you can contact a navigator or broker, or the Customer Support Center (see box below).
  • Select a QHP plan and submit payment: If Healthplanfinder tells you that you qualify for a SEP, you will need to select a QHP through Washington Healthplanfinder.  Submit your premium payments for coverage directly to your insurance company (not to Healthplanfinder). 
  • Provide documentation of qualifying event: Documentation of a qualifying life event may be requested by your insurance company and should be submitted according to their instructions.
  • Respond to any letters you receive through mail/email: Healthplanfinder and your insurance company might send you letters or emails related to your application or your coverage after you request a SEP. Do not ignore these letters; respond to make sure your request for coverage is complete.  The notices you receive will tell you who to contact if you have questions.

Do I need to report changes?

Yes. Once you enroll in Washington Apple Health or a Qualified Health Plan, you will get a letter explaining what changes in your income or household you have to report because they might affect what help you get.

What if I disagree with the decision to deny a SEP?

You have the right to appeal a denial of a SEP.  If your request is denied through Healthplanfinder, appeal by contacting the Exchange Appeals Program. You should file an appeal with the Exchange as soon as possible, within 90 days of the date on the decision letter from Healthplanfinder. You can ask for an appeal online at http://www.wahbexchange.org/new-customers/appeals/, by calling the Healthplanfinder at 1-855-923-4633 (1-855-WAFINDER), or by emailing: appeals@wahbexchange.org .

  • If your request is approved through Healthplanfinder and you select a plan, but your insurance company denies you coverage because they did not receive sufficient or timely documentation of your qualifying life event, contact the insurance company. If you disagree with the outcome, you may file a complaint with the Office of Insurance Commissioner (OIC) at: https://www.insurance.wa.gov/complaints-and-fraud/file-a-complaint/. Additional appeal rights may be available; contact CLEAR at the number below. 

Find Help If You Need It:

  • Find a navigator or broker (in-person help) near you by clicking on the CUSTOMER SUPPORT link in the upper right-hand corner of the www.wahealthplanfinder.orghome page.
  • Call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633, 8:00 a.m. to 5:30 p.m., Monday-Friday.
  • For legal help: call CLEAR at 1-888-201-1014

Footnote[1] The qualifying events listed are for QHPs sold on the Washington Health Benefit Exchange (Healthplanfinder). Some but not all of these events qualify a household for an SEP if you apply for coverage sold outside of this marketplace.

 

Prepared by Northwest Health Law Advocates – August 2016

Last Review and Update: Oct 03, 2016
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