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Small Business Employee Benefits and HR Blog

What Open Enrollment 2015 Means to Employees

With open enrollment for individual health insurance coming up in November, now is a good time for employees and clients to start thinking about their healthcare needs and what open enrollment means for them.Fotolia_46669875_S

For individuals seeking coverage in 2015, the open enrollment period will run from November 15, 2014 to February 15, 2015. During open enrollment 2015 individuals can purchase a new individual health insurance policy, or switch policies for coverage that better fits their needs.

This is particularly good news for anyone who:

  • Missed the last open enrollment period that ended on March 31, 2014.

  • Missed their window to sign up for coverage during a special enrollment period, such as loss of job-based coverage or change in family size (more on special enrollment periods below).

  • Wants to change their policy or coverage. For example, an individual may choose to switch to a policy with a higher deductible and lower premium if they feel they are paying too much month-to-month. Or, if an individual is spending more on out-of-pocket medical costs than they had anticipated in 2014, they may wish to switch to a higher to a policy that has a higher premium with more comprehensive coverage.

Important Dates for Open Enrollment 2015

The specific annual open enrollment and special enrollment periods for individual health insurance are new as of 2014. This is to ensure that individuals don’t wait until they get sick, or are in need of an expensive medical procedure to enroll in coverage or switch to a more comprehensive policy. Here are important dates to remember about signing up for individual health insurance:

  • March 31, 2014: Open Enrollment for 2014 ended

  • November 15, 2014: Open Enrollment for coverage in 2015 begins

  • February 15, 2015: Open Enrollment for coverage in 2015 ends

Tip: Individuals who currently have an individual health insurance policy should check with the insurer about when the policy ends to review their renewal options. Some policies purchased through the Marketplace will allow auto-enrollment for current Marketplace consumers, meaning the policy will auto-renew if no action is taken.

Special Enrollment Periods

Aside from the annual open enrollment periods, individuals may purchase a new individual health insurance policy, or switch their existing policy, if they experience a “Qualifying Life Event.” Qualifying Life Events can include the following circumstances for an individual:

  • Making a permanent move to another state

  • Changing in family size, including:

    • Marriage

    • Divorce

    • Birth/adoption of a child
  • Gaining citizenship

  • Returning from active military duty

  • Being released from incarceration

  • Changing dependent status after turning 26

  • Losing employer-sponsored insurance

  • Being determined newly eligible or ineligible for advance premium tax credits, regardless whether the individual is already enrolled in a qualified health plan

Generally, an individual has 60 days from the trigger of a Qualifying Life Event to enroll in a policy.

Options Outside of Open Enrollment (Without a Qualifying Life Event)

If an individual misses the open enrollment period, and does not have a qualifying life event that makes them eligible for a special enrollment period, then they will have to wait until the open enrollment period starts again the next year to purchase or change their health policy.

If waiting until open enrollment isn’t an option and an individual needs coverage sooner than the next open enrollment period, one option is to purchase a short-term health insurance. While short-term health insurance can provide coverage, it is not considered minimum essential coverage under the Affordable Care Act (ACA). So, even if you enroll in and maintain short-term coverage, you may still be subject to the Individual Shared Responsibility tax penalty.

Also, if an individual qualifies for a government-sponsored program, enrollment is available at any time during the year. These programs include:

  • Tricare (available to active duty and retired military)

  • Medicaid (available for low-income families, children, pregnant women, the elderly and people with disabilities)

  • CHIP (Children’s Health Insurance Program)

  • Indian Health Service/tribal program (available to individuals of Native American descent)

Read more: FAQ - What If I Miss Open Enrollment for an Individual Health Plan?

What questions do you have about open enrollment 2015? Leave a comment.The Comprehensive Guide to the Small Business HRA