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Small Business Employee Benefits and HR Blog

Health Insurance Marketplace Annual Enrollment Period FAQs

Starting in 2014, health insurance insurance companies will be prohibited from denying coverage to people in the individual health insurance marketplaces because of a pre-existing condition.

But, there's a catch. That is, consumers can only enroll in guaranteed issue health insurance during during annual enrollment periods defined in the exchange regulations. Here are some frequently asked questions regarding the health insurance marketplace enrollment periods.

annual enrollment period

1. What Enrollment Periods will the Health Insurance Marketplaces provide?

The health insurance marketplaces will be required to provide an:

  1. Initial open enrollment period, and

  2. Annual open enrollment period.

The health insurance marketplaces must also provide special enrollment periods throughout the year for those individuals and families who meet certain requirements (see FAQ #5 below).

2. When is the initial open enrollment period?

The initial open enrollment period begins October 1, 2013 and extends through March 31, 2014.

3. When is the annual open enrollment period?

For plan years beginning on or after January 1, 2015, the annual open enrollment period begins November 15th and extends through February 15th of the preceding calendar year.

4. When will I be notified of the annual open enrollment period?

Starting in 2014, the health insurance marketplaces must provide a written annual open enrollment notification to each enrollee no earlier than September 1st, and no later than September 30th.

5. What are the special enrollment periods?

The Health Insurance Marketplaces must allow individuals and enrollees to enroll in or change from one plan to another as a result of the following triggering events:

  1. An individual or dependent loses minimum essential coverage.

  2. An individual gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption.

  3. An individual, who was not previously a citizen, national, or lawfully present individual gains such status.

  4. A qualified individual’s enrollment or non-enrollment in a plan is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Health Insurance Marketplace or HHS, or its instrumentalities as evaluated and determined by the Health Insurance Exchanges.

  5. An enrollee demonstrates to the Health Insurance Marketplace that the plan in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee.

  6. An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. For example, the marketplace must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan.

  7. A qualified individual or enrollee gains access to new QHPs as a result of a permanent move.

Unless specifically stated otherwise, an individual or enrollee has 60 days from the date of a triggering event to select a plan.

6. Why are there annual enrollment periods?

Annual enrollment periods ensure that individuals and families don’t wait until they get sick to enroll in coverage, or switch to more comprehensive coverage when they are about to have an expensive medical procedure.