Starting in 2014, health insurers will be prohibited from denying coverage to people in the individual health insurance marketplaces because of a pre-existing medical condition. This is commonly referred to as "guaranteed-issue."
But... Consumers can only enroll in guaranteed-issue health insurance during specific open enrollment periods, as defined by the Affordable Care Act exchange regulations.
The open 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.
Open Enrollment Periods for the Health Insurance Marketplaces
The health insurance marketplaces will have the following enrollment periods:
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Initial open enrollment period: The initial open enrollment period for the health insurance marketplaces begins October 1, 2013 and extends through March 31, 2014.
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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.
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Special enrollment periods: The health insurance marketplaces must also provide special enrollment periods throughout the year for those individuals and families who meet certain requirements (detailed below).
| Enrollment Period: | From: |
| Initial Open Enrollment (for coverage in 2014) | October 1, 2013 to March 31, 2014 |
| Annual Open Enrollment (for coverage in 2015) | November 15, 2014 to February 15, 2015 |
| Special Enrollment Period (after a qualifying event) | Generally 60 days from qualifying life event |
Special Enrollment Periods for Health Insurance Marketplaces
In addition to the standard open enrollment periods, the Health Insurance Marketplaces will allow individuals and enrollees to enroll in or change from one plan to another as a result of the following triggering events (aka 'qualifying life event'):
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An individual or dependent loses minimum essential coverage.
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An individual gains a dependent or becomes a dependent through marriage, birth, adoption or placement for adoption.
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An individual, who was not previously a citizen, national, or lawfully present individual gains such status.
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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.
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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.
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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.
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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.
Notification of Annual Open Enrollment Period
Starting in 2014, the health insurance marketplaces must provide a written annual open enrollment notification to all enrollees no earlier than September 1st, and no later than September 30th.
What are the state health insurance marketplaces? Look up your state health insurance marketplace here.
