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Health care plans, special enrollment and qualifying events

Losing your job is a qualifying event for having to drop out of your company health care plan. In fact, the term “qualifying event” is language you see all over the health care insurance map.

“Special enrollment” is another term you will see associated with various plans. What does all this mean?

The main event

If you are enjoying the benefits of a company health care plan, those benefits will come to a halt if you receive a pink slip. Losing health care is an unsettling experience, especially if you have a family to worry about. However, you now have a qualifying event that allows you to explore other health care plan opportunities. In the meantime, if it meets the requirements, your company plan is probably linked to COBRA, which will provide you with continuation coverage. The drawbacks are, first, that COBRA will only be in force for a specified period of time, and second, that it is expensive coverage.

HIPAA help

The Health Insurance Portability and Accountability Act provides a safety net for you and your dependents. Under HIPAA rules, if you become ineligible for group health care coverage, including continuing COBRA coverage, you can explore “special enrollment.” This means that you can apply for inclusion in a new group plan at any time of the year, not just during the annual open enrollment period. For example, if your spouse has group coverage, you might be able to special enroll in that plan. You could also explore special enrollment in the Health Insurance Marketplace, which features “one-stop shopping” for private health care plans.

Considerations

Qualifying events that will affect your insurance coverage include not only job loss, but also marriage, a new baby in the family, a divorce or the death of a loved one. These are the types of life changes that will guide your next decision relative to health insurance.

In COBRA, you will likely find only the minimum requirements for continuation coverage. Limitations may exist in other plans, as well. There is also the possibility that you would be denied coverage or that a delay you did not expect will interrupt the medical care a family member requires. Explore your options and get the answers you need to make an informed decision about the next steps to take.

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Jon Michael Smith Attorney

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