Open Enrollment Period
Open Enrollment is the period of time during a year when a business, Medicare eligible, or individual is permitted to purchase, change, or terminate insurance coverage.
For businesses, open enrollment refers to the time when employees are able to make additions, changes, or waive their employer’s offered coverages. Fully insured carriers usually permit employers to make employee changes to elections 30 days prior to the group’s renewal date. The open enrollment window of the carrier can be flexible if there is a business reason for a different time period, such as a calendar year plan, a different fiscal year, or if the group makes major plan changes. However, we do recommend requesting prior approval. Small groups that do not meet participation can purchase ACA plans for a January 1 effective date as long as their application is received by the official Open Enrollment Period deadline (typically November 15 to December 15 each year).
Individuals and families can enroll in plans from November 1 to December 15 each year with starting dates of January 1 the next year.
Medicare eligible can enroll in a plan between October 15 and December 7 (the early shopping period begins October 1). Plans start January 1.
Special Enrollment Period (SEP)
Special Enrollment Period (SEP) is a time outside of Open Enrollment when you can sign up for health insurance. Usually, you qualify for SEP due to certain qualifying events such as:
- Legal separation
- Termination of employment for the employee or their spouse or dependent
- Reduction or increase in hours worked that changes eligibility for the plan
- A significant change in spouse’s employer’s coverage
- Movement out of area
- Dependent no longer eligible
- The purchase of individual or Medicare coverage
Any changes made must be consistent with the type of life change. For example, the birth of a child would involve adding a child to coverage, but not terminating coverage of a spouse.